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INFANCY AND 
CHILDHOOD 



A Popular B c Care 

of Child? 



BY 

LTERREEV] Y M. D. 

Assistant Professor of Disc-. 

of Minnesota; Associate Visiting P 

University Hospital; Visiting Physician t 
Paul City and County Ho 

Director of St. Paul Baby We 
Association 



IPANY 




o 






INFANCY AND 
CHILDHOOD 



A Popular Book on the Care 
of Children 



BY 

WALTER REEVE RAMSEY M. D. 

Assistant Professor of Diseases of Children, University 

of Minnesota; Associate Visiting Physician to the 

University Hospital; Visiting Physician to St. 

Paul City and County Hospital; Medical 

Director of St. Paul Baby Welfare 

Association 



NEW YORK 

E. P. DUTTON & COMPANY 

681 Fifth Avenue 
1916 



.1^2. 



Copyright, 1916 
By E. P. DUTTON & COMPANY 



MAR 20 1916 
S)C!.A428164 

*H4> / . 



DEDICATED 

TO 

MY WIFE AND LITTLE BOY, FROM 

WHOM MUCH OF THE INSPIRATION 

IN THE WRITING OF THIS BOOK 

HAS COME 



PREFACE 

In the writing of this book I have had constantly 
in mind the now recognized fact that, in order to 
accomplish anything in the way of preventive medi- 
cine, there must be an intelligent cooperation of the 
public. 

Whatever progress is made in child-welfare will 
be largely along educational lines. 

The future well-being of the average child which 
is normal at birth depends to a great extent upon the 
physical and moral care it receives. For the first 
years, which in many respects are the most important 
in the life of the individual, this care devolves largely 
upon the mother and nurse. 

The old-time mysticism, which still to some ex- 
tent surrounds medicine, must disappear and the 
public be taught what it may rightfully expect of 
itself and the physician. 

It does not follow that the mother need have a 
technical knowledge of medicine. She should, how- 
ever, have an intelligent idea of foods and their 
values and at least a knowledge of the fundamen- 
tals of hygiene. 

vii 



viii PREFACE 

She should have a sufficient knowledge of disease, 
especially the contagious forms, to understand their 
significance, the manner in which they are carried, 
and the means of prevention. 

For example, she should know that a croup which 
persists for many hours, with progressive difficulty 
in breathing, may be a laryngeal diphtheria and that 
a physician should be summoned immediately, as the 
child's life may be in great danger. 

She should know that a high fever, severe vomit- 
ing and diarrhea, or any other severe symptom, is 
never due to teething but to some other cause. 

With the hope of aiding her to a better knowl- 
edge of such practical points as these, this book 
has been written. 

W. R. R. 

St. Paul, January 3, 191 5. 



INTRODUCTION 

The interest in child welfare during the past few- 
years has been especially marked. Men and women 
in all walks of life have joined hands in advancement 
of the cause. Societies have been formed in almost 
every city in America and Europe for the preven- 
tion of infant mortality and for the general improve- 
ment of conditions relative to child life. 

Why this world-wide interest, this great concern 
so lately awakened? 

While the advancement of science has greatly 
diminished the mortality among adults, the infant 
death rate has remained practically at a standstill. 

In the United States one infant out of every seven 
which come into the world dies before it has reached 
the end of the first year. When one considers that 
most of these infants are normal at birth the condi- 
tion is all the more shocking. 

The belief generally held that infant mortality is 
simply a matter of natural selection, that the fittest 
survive and that the race is thereby made stronger, 
is no longer tenable. 

The fact is that many children although they sur- 
vive the first year are much less " fit " as a result 

ix 



x INTRODUCTION 

of illness and defective feeding, and not a few of 
them succumb later or carry through life the effects 
of a bad early environment. What, then, is the 
cause of this appalling death rate in infants? 

Ignorance and bad social conditions are respon- 
sible for the greater part of the preventable death 
rate in infants. Ignorance on the part of society 
in general and of parents in particular concerning 
the fundamental conditions underlying child life and 
development. 

Many women are forced to do work which under- 
mines their health and makes them unfit to give birth 
to healthy children. 

The substitution of artificial for breast feeding is 
responsible for a large percentage of the deaths 
among infants. The breast-fed baby has six times 
as many chances of surviving the first year as the 
artificially fed infant. 

Crowding into cities where the cost of living is 
so high that neither the mother nor the infant has 
the proper housing or food, is also responsible for 
many deaths. 

Until recently the infant has been regarded as a 
miniature adult and was so treated even by the medi- 
cal profession. 

It is now known that the physiology of the in- 
fant is vastly different in many respects from that of 
the adult. In the infant we have to do with a sen- 



INTRODUCTION xi 

sitive, unstable and rapidly developing organism 
which must be supplied with the elements necessary 
to its growth, while in the adult it is only necessary 
to repair body waste. How can we prevent this un- 
necessary sacrifice of child life? 

By educating fathers and mothers concerning their 
own care and the care of their children. By improv- 
ing social conditions so that women employed will 
have proper sanitary conditions under which to live 
and work, a living wage and a proper knowledge of 
food and food values. 

How can this be done? 

Young women must be taught more at home and 
at school concerning the fundamentals which will fit 
them to be wives and mothers. 

Proper legislation if enforced would do much to 
remedy some of the evil conditions. 

Among the educated classes much may be taught 
through proper literature. 

For immediate results we must depend to a great 
extent upon properly educated physicians, nurses and 
social workers, who will devote much of their time 
to spreading useful knowledge and to uprooting false 
ideas, whenever and wherever they may be found. 

We are interested not only in saving the lives of 
infants but also in promoting their physical and 
moral welfare, so that they shall be the greatest pos- 
sible benefit to society and to themselves. 



CONTENTS 
INTRODUCTION 

PAGE 

History of the Progress in Child Welfare During the 
Past Few Years. Cause of Large Death Rate in 

Infants. Education, etc ix 

CHAPTER I 

STRUCTURE OF THE BODY 

The Skeleton i 

The Skull 2 

The Teeth 3 

The Spine 4 

Development of Soft Parts of the Body 5 

The Heart and Circulation of the Blood 6 

Respiration — Lungs and Chest Wall 7 

Brain and Nervous System 8 

Digestive Tract 9 

The Stomach 10 

The Intestines 11 

CHAPTER II 

GROWTH AND DEVELOPMENT 

Average Weight at Birth 13 

Gain in Weight and Length 13 

Development of Boys and Girls During Puberty . . 14 
Table Showing the Average Weight, Height, and Cir- 
cumference of Head of Boys for the First Ten Years 17 
Significance of Head Measurements, Movements, etc. . 20 

Loss in Weight After Birth 20 

The Normal Infant — Methods of Examination . . 21 

Natural Movements of the Body 22 

xiii 



xiv CONTENTS 

PAGE 

Rickets as Cause of Delayed Development .... 23 
Development of the Special Senses — Seeing, Hearing, 

Talking, etc 24 

The Mental and Moral Development of the Child. 

"Home Training" 26 

CHAPTER III 

THE NURSE 

Qualifications, etc 37 

CHAPTER IV 

CARE OF THE NEW BORN 

Care of the Cord 39 

Hernia (Rupture) 40 

Bathing 42 

Care of the Skin 43 

Care of the Genital Organs 44 

Care of the Eyes 45 

Care of the Mouth 46 

Clothing of Young Infants 47 

The Nursery 52 

Airing Out of Doors 54 

Sleep 55 

Temperature 56 

Premature Infants 57 

CHAPTER V 

BREAST FEEDING 

Low Mortality of Breast Infants 60 

Secretion of Milk 61 

Discussion of Patent Foods in Comparison with Breast 

Milk 62 

Technique of Breast Feeding 63 

Quantity of Milk Secreted, etc 64 

Menstruation and Pregnancy in the Mother . . 67, 68 

Fissured Nipples 68 



CONTENTS xv 

PAGE 

Mixed Feeding 69 

Weaning 70 

The Wet Nurse 70 

CHAPTER VI 

ARTIFICIAL FEEDING 

General Discussion of Milk and Artificial Foods . 72 

Care of Milk in the Home 75 

Composition of Cow's Milk as Compared with Mother's 

Milk 78 

Modification of Cow's Milk for Infants 79 

Quantity of Food at a Meal 82 

Different Milk Formulae 82 

Fat, Sugar and Gruels 84 

Substitutes for Fresh Milk 91 

Proprietary Foods 91 

Special Preparations of Milk 92 

Peptonized Milk, etc 92 

Bottles and Nipples 95 

Sterilizers and Pasteurizers 97 

Ice Box 98 

CHAPTER VII 

TEETHING (DENTITION) 

Temporary and Permanent Teeth 100 

Symptoms Due to Teething 100 

Care of the Teeth 102 

Results of Decayed Teeth 102 

CHAPTER VIII 

THE STOOLS AND URINE 

Constipation 106 

Urine 109 

CHAPTER IX 

OVERFEEDING 

Vomiting 112 



xvi CONTENTS 

PAGE 

Colic 114 

CHAPTER X 

DIET 

Diet for Children from One to Two Years . . . .115 
Diet for Children from Two to Five Years . . . .116 

CHAPTER XI 

EXERCISE 

Exercise for Infants 122 

Exercise for Older Children 123 

CHAPTER XII 

DISEASES OF THE RESPIRATORY TRACT 

Cold in the Head 125 

Croup 126 

Bronchitis 127 

Pneumonia 130 

Grippe 131 

CHAPTER XIII 

CONTAGIOUS DISEASES 

Tuberculosis 132 

Diphtheria 134 

Scarlet Fever 138 

Measles 140 

Smallpox 141 

Chicken Pox 141 

Mumps 142 

Whooping Cough 142 

Erysipelas 144 

Gonorrhea 145 

Syphilis k . . 146 

Quarantine 147 

Disinfection 148 



CONTENTS xvii 

PAGE 

CHAPTER XIV 

MISCELLANEOUS 
Melena Neonatorum (Bleeding of the New Born) . . 150 

Convulsions 151 

Worms 152 

Adenoids 155 

Enlarged Tonsils 156 

Enlarged Glands 157 

Rheumatism and Chorea 158 

Earache 159 

Goiter 159 

Cretinism 160 

Rickets 161 

Scurvy 162 

Hives (Urticaria) 163 

Milk Crusts (Eczema) 164 

Thrush. Stomatitis 165 

Summer Diarrhcea 166 

Vaccination 168 

Kissing 169 

Habits 169 

Thumb Sucking 169 

Facial Movements 170 

Bed Wetting 171 

Masturbation 172 

Proper Use of the Eyes 173 

Errors of Refraction 174 

Malnutrition 175 

Delicate Children 176 

Puberty 177 

Clothing for Older Children 179 

Toys 180 

Foreign Bodies 181 

Enlargement of Breasts in Infants 182 

Care of Wounds 182 

Milk for Traveling 183 

Table of Caloric Values 185 

Dietary 185 

Index , m n . m 189 



LIST OF ILLUSTRATIONS 

"Wrapped in Warm Blankets and Out of Harm's Way" 

Frontispiece 

PAGE 

Fairbanks Baby Scale 15 

Fairbanks Scales 15 

Weight Curve of the First Year 19 

Outdoor Activities Which Keep Children Healthy ... 30 
11 In the Country There Is Always Something to Interest 

and Instruct the Child " 34 

The Correct Treatment of Abdominal Hernia .... 40 

The Skull of an Infant 42 

"At Eleven to Twelve Months the Child Will Stand by 

Taking Hold of Things " 42 

Folding Bath-Tub 42 

Handy Folding Table for Bathing and Dressing the Baby 50 

A Knitted Hammock for the Baby 53 

A Child Should Have Much Exercise in the Open Air, 

Both Summer and Winter 54 

Nursery Pen 56 

" In An Open Shady Grass Plot Under the Trees " . . .56 

Simple Incubator for Premature Infants 57 

Breck Feeder 58 

Breast Feeding — The Proper Position for Nursing the 

the Baby 60 

Breast Pump 65 

Nipple Shield 69 



LIST OF ILLUSTRATIONS 

PAGE 

A Modern Sanitary Cow Stable Contrasted With the Old 

Style Disease-Breeding Conditions 74 

Chapin Cream Dipper 80 

Cream Dipper in Use 80 

Pint Graduate 84 

Nursing Bottle With Correct Nipple 96 

The Arnold Steam Sterilizer and Pasteurizer .... 96 

A Simple Home-Made Ice Box 97 

Temporary or Milk Teeth 99 

Permanent Teeth 101 

Soft Rubber Syringes 108 

Simple Vaporizer 128 

A Simple Arrangement for Steaming Which can Be Fitted 

to the Child's Bed 129 

Simple Screened Bed for Outdoor Sleeping . . . .177 



INFANCY AND CHILDHOOD 



INFANCY AND CHILDHOOD 



STRUCTURE OF THE BODY 

The body of the infant consists of : — 
i. The skeleton, or bony framework. 

2. The soft parts, which are made up of liga- 
ments, muscles, blood-vessels, nerves, digestive and 
urinary organs, etc. 

3. A liquid portion, consisting of blood and 
lymph. 

THE SKELETON 

Cartilage. The skeleton of the infant, unlike 
that of the adult, contains a large amount of 
cartilage. This is relatively soft compared with 
bone, but later, by the process of multiplication of 
the bone cells and the deposition of lime salts, it is 
transformed into bone proper. 

The skeleton, or bony framework, including the 
cartilage, serves a variety of purposes. It serves 
as a protection for the most vital and sensitive por- 
tions of the body — the brain, which is enclosed 
within a bony shell, the skull ; the spinal cord, which 



2 INFANCY AND CHILDHOOD 

is enclosed within the spinal canal; and the lungs 
and heart, which are enclosed within the chest w T all. 

The Chest Wall. The chest wall serves not only 
as a protection to the organs mentioned, but also, 
in connection with certain muscles, as an aid to 
breathing. The bones also serve as an attachment 
for the muscles which by their contraction, produce 
the power of motion. 

Ligaments. The different bones in the infant 
are rather loosely held together by fibrous ligaments, 
so that there is a considerable amount of freedom of 
motion in all directions and there may be even some 
over-riding of the ends of the approximating bones. 

Change in Shape of Head at Birth. This is 
particularly true of the bones of the skull, which 
during a difficult birth so overlap, that for a short 
time the shape of the head may be changed. The 
bony framework of the head can be roughly divided 
into two parts: the cranium, which contains the 
brain, and the bones of the face. 

THE SKULL 

The Jaws. In the infant the upper portion of 
the skull is much greater in proportion to the lower, 
than in the adult. This is a result of the undevel- 
oped condition of the jaws. 

The cranium is composed of thin curved plates 
of bone rather loosely held together. 



STRUCTURE OF THE BODY 3 

Sutures. The spaces between the opposing 
edges of the different bones in the skull are called 
sutures. 

Fontanels. The large, four-sided opening 
which exists at the upper, forward part of the skull, 
at the juncture of the two frontal and two parietal 
bones, is called the large fontanel, and the small 
triangular opening at the juncture of the two parietal 
bones with the occipital, is called the small fontanel. 
(See cut facing page 42.) 

The Brain. The brain lies within the skull 
and its growth and development have undoubtedly 
much to do with the size and shape of the head. 

Time of Closure of the Fontanels. The su- 
tures, as well as the small fontanel, close normally 
at the end of the first year, while the large fontanel 
does not normally close until the end of the fif- 
teenth to eighteenth month. Closing of the fonta- 
nels before the end of the first year may mean a 
limited brain development, a condition known as 
microcephalus. The nonclosure of the large fon- 
tanel after the eighteenth month, usually indicates 
the presence of rickets. 

THE TEETH 

At birth the teeth are well formed in the jaws 
and continue to grow so that, at the end of the sixth 
or eighth month after birth, the first teeth usually 



4 INFANCY AND CHILDHOOD 

pierce the surface of the gums. The last ones ap- 
pear normally about the thirtieth month. 

The process of teething, therefore, contrary to 
what is generally believed by the laity, is practi- 
cally continuous, extending from the sixth to the 
thirtieth month. (For " Teething " see page 99.) 

THE SPINE 

The spine or vertebral column consists of thirty- 
three segments or vertebrae placed one on top of 
the other, separated by cushions of connective 
tissue, the whole column being held together by 
ligaments. 

The Vertebrae. These vertebrae consist 
largely of cartilage. The vertebrae form a bony 
canal which serves to protect the spinal cord from 
injury. 

Spinal Nerves. Through small openings, or 
foramina, come the nerves which carry the im- 
pulses to and from the brain. 

Curvature of the Spine. As the erect position 
of the spinal column can be maintained only by 
muscular contraction, and since in the young in- 
fant these muscles are undeveloped, the erect posi- 
tion of the body should never be enforced, as ab- 
normal curvatures may result. 



STRUCTURE OF THE BODY 5 

DEVELOPMENT OF SOFT PARTS OF THE BODY 

The Skin. During the first few days after 
birth the skin of the new born infant is often 
intensely red. This redness gradually fades until, 
at the end of the second week, the skin assumes a 
pink color which from then on is characteristic of 
the normal breast infant. 

The Hair. The fine hair which covers the 
body of the new born usually disappears after a 
few weeks, as does the copious growth of hair 
which often occurs on the head. This hair may 
persist for a considerable time and then fall out, to 
be replaced by another crop less profuse and fre- 
quently of a different color. 

The skin of the new born baby is extremely 
tender and particularly susceptible to irritation 
either by undue friction or by irritating substances, 
such as impure soap or the discharges from the 
body, urine, stool and perspiration. 

Color of Mucous Membrane. The tissue of 
the healthy breast infant is relatively richer in fat 
than that of older children. 

The tissues of the healthy infant are characteris- 
tically firm and resilient. The first evidence of the 
disappearance of the fat from the body is shown 
by the flabby character which it assumes in com- 
parison to the firm feeling of normal flesh. 



6 INFANCY AND CHILDHOOD 

The mucous membranes of the new born infant 
are also extremely red at birth but gradually be- 
come paler and assume after a couple of weeks the 
natural pink color. 

THE HEART AND CIRCULATION OF THE BLOOD 

Oxygenation of the Blood. The heart begins 
to beat and send blood through the vessels as early 
as the second month of foetal life. Since, how- 
ever, the blood of the unborn child is dependent 
for its oxygen upon the placenta of the mother, its 
circulation is somewhat different from that of the 
child after birth. At birth, when the cord is sev- 
ered, the child begins to breathe so that all blood 
must go through the lungs in order to get oxygen. 

Heart Valves. Valves and vessels which were 
necessary before birth now become unnecessary and 
must permanently close before proper circulation 
is possible. If for any reason the free circulation 
through the lungs is interfered with, the blood will 
not receive sufficient oxygen and will become blue 
in color. Such a condition exists in the so-called 
"blue baby." 

Frequency of Heart Beat. The frequency of 
the heartbeat during infancy is considerably 
greater than in older children and adults. At birth 
the heart beats 120 to 140 times per minute. At 
the end of the first year the frequency has been 



STRUCTURE OF THE BODY 7 

reduced to 1 00-110. From this time on the heart- 
beat gradually diminishes in frequency, until at six 
years it averages 80-90 per minute. These are 
averages and are to be taken only when the child 
is quiet and undisturbed. 

RESPIRATION 

The lungs are situated within the chest wall and, 
together with the heart and large blood vessels, 
practically fill that cavity. It is by means of the 
lungs that the blood comes in contact with the air, 
taking up oxygen and giving up the waste gases 
such as carbondioxide. 

The act of breathing begins immediately after 
birth. 

The frequency and rhythm of the respiration in 
infants is considerably different from that of older 
children and adults. The breathing is more fre- 
quent and irregular in character than in later years. 

Chest and Abdominal Breathing. There is 
comparatively little movement of the chest wall 
in infants and most of the breathing is done by 
means of the diaphragm, that is, so-called abdominal 
breathing. Gradually as the infant grows older 
and as the chest muscles become more developed 
the chest breathing increases. 

Character of Breathing. The rhythm of the 
breathing in infants is irregular. This irregularity 



8 INFANCY AND CHILDHOOD 

is not infrequently the source of much concern to 
mothers, as it is particularly noticeable during 
sleep. 

Frequency of Breathing. While the fre- 
quency of breathing in adults is 18-20 per minute, 
in infants during the first month it is as high as 
30-40, and even in the second year it is 25-30 per 
minute. 

Nose and Mouth Breathing. Air should 
normally enter the body through the nose. When 
an infant does not breathe through its nose, and 
the mouth remains open during sleep, it means some 
obstruction in the nasal passage, either in the nose 
itself, or behind the nose, usually in the form of 
adenoids, which condition is not infrequent even 
in the new-born infant. 

THE BRAIN AND NERVOUS SYSTEM 

Growth of Brain. At birth the brain and cen- 
tral nervous system are, at least to all appearance, 
well developed. As early as the eighth month 
after birth the brain of the infant is so well de- 
veloped that, in comparison with the brain of the 
adult, no great difference can be detected. The 
growth of the brain during the first year is very 
rapid, in fact the growth during the first year equals, 
or exceeds, the growth during the entire remain- 
ing life of the individual. 



STRUCTURE OF THE BODY 9 

Many of the bodily functions at birth are but 
poorly developed. 

Of all animals the young infant is by far the most 
helpless, and for the first few years or so is en- 
tirely dependent. 

Organs of Sense, The organs of sense during 
the first few weeks show very little development 
of function, although at an early age the infant is 
able to appreciate heat, cold and pain. Taste 
usually develops early; sweet things are taken bet- 
ter than sour or bitter. 

Eye Movements. The eyes of the baby dur- 
ing the first few days, or even weeks, make all 
sorts of incoordinate movements and at times a 
positive squint is present. This, however, is but 
temporary and is due to the lack of muscular con- 
trol. An infant acquires the ability to fix its eyes 
upon objects at about the third month. 

Winking and Shedding Tears. Winking is 
seldom seen in the new-born baby, as is also the 
shedding of tears. After the first few weeks the 
winking of the eyelids becomes more frequent and 
tears begin to appear. 

DIGESTIVE TRACT 

The digestive tract begins at the mouth and ends 
at the anus. 



io INFANCY AND CHILDHOOD 

Sucking. The act of sucking is a complicated 
procedure and one which demands for its consum- 
mation the following organs: The jaws, the 
tongue, the cheeks and the roof of the mouth. If 
any of these parts are deficient in development the 
act is liable to be impaired. 

Digestion of the milk begins in the mouth 
through the influence of the secretion from the 
salivary glands. The digestive action of these se- 
cretions is at first very feeble but increases consid- 
erably during the first three months. 

Gastric Secretion. After passing through the 
mouth the food enters the esophagus and by muscu- 
lar contraction is carried to the stomach, where it 
is acted upon by the secretions of that organ (gas- 
tric juice). The most active ferment in the in- 
fant stomach is the rennet, which results in the 
curdling of the proteid element of the milk. Pepsin 
and hydrochloric acid are present in the stomach 
of the new-born infant in small quantities. These 
secretions are undoubtedly rather inactive during 
the first weeks of life. 

THE STOMACH 

The form and position of the stomach of the 
infant is not unlike that of the adult, occupying 
rather an oblique position in the upper left side 
of the abdomen just below the heart under the 
diaphragm and extending from left to right. 



STRUCTURE OF THE BODY n 

The small end of the stomach is closed by a 
circular muscle known as the pylorus. This opens 
at intervals as a result of chemical and nervous in- 
fluence combined, and the contents are forced 
through by rhythmic muscular contraction into the 
small intestine. 

THE INTESTINES 

Small Intestine. The intestinal canal is di- 
vided anatomically into two parts, the small and 
large intestine. The length of the intestinal canal 
is relatively longer than in the adult. In the infant 
the intestinal canal is approximately six times the 
length of the body, while in the adult it is only four 
and a half times as long. 

Digestion in the Small Intestine. The milk is 
largely digested in the upper portion of the small 
intestine, through the influence of the secretions 
from the pancreas and the liver. 

The Large Intestine and Its Functions. Very 
little digestion occurs in the large intestine, al- 
though it has some ferments capable of digestion. 
A great deal of the absorption of the liquid por- 
tion of the food, however, takes place in the colon 
(large bower). 

Bacteria in the Intestinal Canal and Their 
Function. The whole intestinal tract at birth 
is free from any form of bacteria, but after twenty- 



12 INFANCY AND CHILDHOOD 

four to thirty-six hours it contains millions of bac- 
teria of many varieties, some of which undoubtedly 
have much to do in assisting in the digestion and 
assimilation of the food. 



II 

GROWTH AND DEVELOPMENT 

Average Weight at Birth. Although there is 
considerable variation in the size of individual in- 
fants at birth, the average for boys is about seven 
and a half pounds and for girls about seven 
pounds. 

There is almost always some loss in weight di- 
rectly following birth, which will be explained in 
chapter on Breast Feeding, page 61. 

Gain in Weight. During the first three 
months the gain of a normal infant is from four 
to six ounces per week, or from one to one and one- 
half pounds per month. It is rather the exception 
that infants will maintain a gain of two pounds per 
month during the first three months. 

Gain in Weight During the First Year. At 
six months the weight should be about double that 
at birth, which for the entire time is an average of 
a little over one pound per month. During the 
second half of the first year the gain in weight is 
not quite so rapid as during the first half. 

At the end of the first year the weight should 
be approximately three times that at birth. 

13 



14 INFANCY AND CHILDHOOD 

This tremendous gain in weight during the first 
year explains the large amount of food needed per 
pound of body weight during this period. 

After the first year the gain in weight is not so 
rapid. 

Gain in Weight During Second Year. Dur- 
ing the second year the child should gain three- 
fourths of a pound per month, or eight or nine 
pounds during the year. 

Gain in Weight to Fifth Year. During the 
third year it should gain about four or five pounds, 
during the fourth about four pounds, and during 
the fifth, four and a half pounds, so that at five 
years the child should weigh forty or forty-two 
pounds. 

The average weight of boys is one to one and a 
half pounds greater than girls at the same age. 

Development of Boys and Girls During Pu- 
berty. At the time of puberty, which comes 
earlier in girls than in boys, the girls forge ahead 
of the boys. Later, however, the boys regain their 
superiority in weight and maintain it until matur- 
ity. 

An approximately normal increase in weight of 
an infant is of vital importance. When an infant 
does not gain in weight for any length of time, 
there is always something wrong either with the 
feeding or with the child itself. 



GROWTH AND DEVELOPMENT 15 




Fairbanks Baby Scale 
Weighing to 35 lbs. 




Fairbanks Scales 
Weighing to 200 lbs. 



16 INFANCY AND CHILDHOOD 

Weighing. Infants should therefore be 
weighed regularly, at least weekly, during the first 
year, and at least once monthly during the second 
and third years. 

The gain in weight is not the only thing in the 
development of an infant to be considered; in fact 
a too rapid increase in weight may be a detriment 
and usually means over- feeding. 

Increase in Length During the First Year. 
The growth in length and a proper general develop- 
ment of the body are equally important with the in- 
crease in weight. 

The average length of the male infant at birth 
is twenty inches and of the female nineteen and a 
half inches. During the first month the infant 
increases in length from one and a half to one and 
three- fourths inches, and during the second month 
slightly less. This increase gradually becomes less 
after the third month, and at the end of the first 
year the increase is about one-half inch per month. 
There is a gain in length of about eight inches dur- 
ing the first year, three and one-half during the 
second year, and three inches during the third year. 
From the third to the eleventh year the gain is about 
two and a half inches per year. 

At the age of puberty there is a more rapid gain 
in height corresponding to the increased gain in 
weight. 



GROWTH AND DEVELOPMENT 17 

Development During Puberty. During this 
period of rapid growth there is an unstable condi- 
tion of the nervous system, the significance of which 
will be discussed under the chapter on " Puberty." 

Table Showing the Average Weight, Height and 
Circumference of Head of Boys: 

The weight of girls at birth is on the average about 
one-half pound less than boys. Their height is only 
slightly less: 

at birth : 

Weight 7J/2 pounds 

Height 2oy 2 inches 

Chest 13^2 inches 

Head 14 inches 

one year: 

Weight 21 pounds 

Height 29 inches 

Chest 18 inches 

Head 18 inches 

two years: 

Weight 2J pounds 

Height 32 inches 

Chest 19 inches 

Head 19 inches 

three years: 

Weight 32 pounds 

Height 35 inches 

Chest 20 inches 

Head 19J4 inches 



18 INFANCY AND CHILDHOOD 

four years: 

Weight 36 pounds 

Height 38 inches 

Chest 20^4 inches 

Head 19^ inches 

five years: 

Weight 41 pounds 

Height 41 y 2 inches 

Chest 21^4 inches 

Head 20J4 inches 

six years: 

Weight 45 pounds 

Height 44 inches 

Chest 23 inches 

seven years: 

Weight 49^ pounds 

Height 46 inches 

Chest 235/2 inches 

eight years: 

Weight 54^2 pounds 

Height 48 inches 

Chest 24J4 inches 

nine years: 

Weight 60 pounds 

Height 50 inches 

Chest 25 inches 

ten years: 

Weight 66 I /2 pounds 

Height 52 inches 

Chest 26 inches 



GROWTH AND DEVELOPMENT 19 

The weights for the first four years are without 
clothes. After that the weights include ordinary- 
house clothes. (After Holt.) 

Some slight variation may occur from these 



WEIGHT CHART. 

Name - Date nf Birth. 
















' 


J ' 


s 



h 


MONTH OF AGE. 


1 2 3 4 5 6 7 8 9 10 11 12 






1 ! ! 1 1 | , |i | . ■ 


, 1 i 1 1 1 . 


: . . j 1 : : 1 . 1 . 1 




! 1 


\CAV\- 




• • • ! ■ 


Ill 1 f 1 


1 i 1 1 « ! ! 






1 1 ! 






,..,, — • 












1C430 23 ' 




. i i : r , 
















I ■ ' ! i 1 ' ' ■■ 1 








■ 1 i , 
















-» v l _, : 


i | | 






VOJL Q. 


1 1 1 1 1 i ' 1 






NEW 20 ; 


| ■ 






' ! 1 1 








8620 19 j 


■ • i ' i 1 i ' 






i ■ , , 1 ■ j . . 1 j I 




\ 1 




■ . 1 : 1 i i ' ■ . i 




; 1 






i^^*** 


"T 






nuivl 




_ -~~*^ 


1 








x ^*0~~~~^ 1 1 






' 




ml 16 ; 




^— n^ 












1 1 






'iii 1 










6800-15 




. 1 , , 




















■ 1 










I'M 








■Mil 




1 • 


1 , . . 












1 1 i 1 


1 1 1 










1 ' ' S 


- : 


' ! ' 










1 I I 


• • 








5900 13 ■ 






■ 1 • ^ 














! ' 1 


i ' 












\/ 












■ ' 




• ' 














X< , 






■ 




1 1 1 


1 1 1 


, , 


i i 1 


~[~[ 








■ S... . ! 










. 


I ! ! 


. 1 1 


• , ■' 


■ 






i i 1 / 










> i ! 






1 1 


| 1 




. . . yr . ; , 














1540 10 j' 




S\ > 1 




1 


































; . fi r •■ 




: ! ' III 




1 j 


3650 
3180 
127^0 


'| 












'' : v 1 r 1 • 






' \Ju 


■ \ . : 


1 


i 




;V: j , 






■ >< 


Tl 










-f f r 






V^ ' 


1 1 






! 1 i 




, r 1 




1 ' l 


1 i 
























1 
















"1 1 1 






















■ U 




I 2270 




! 












. i 1 










I 


, ' 








! , ' 1 M j 


; . , 




r 


1 1 




JJJL 


lit! | 1 


III 


1 1 1 


1 1 1 


XLL 


1 II ■! 1 


i 1 1 






JLLL 



Weight Curve of the First Year 



measurements without having any special signifi- 
cance. For instance, a child born of small parents 
will usually be smaller than one born of large par- 
ents and the weight and measurements will be cor- 



20 INFANCY AND CHILDHOOD 

respondingly less. Any wide divergence from these 
averages means something abnormal. For ex- 
ample, if a baby which weighed seven pounds at 
birth should at three months weigh only eight 
pounds, one would be certain that there was some- 
thing wrong; or if an infant at one year should 
have only the length of an infant of six months it 
would point strongly to " Cretinism " or some other 
abnormal condition. 

Significance of Head Measurements. If the 
head should measure only fourteen inches at the 
end of the first year we should be suspicious as to 
the brain development, or if at one year it measured 
twenty inches instead of eighteen we would feel 
the probability of a Hydrocephalus being present. 

Loss in Weight After Birth, During the first 
few days there is usually a loss in weight " which 
does not occur in other animals." The so-called 
physiological loss in body weight is proportionate 
to the size of the child ; the greater the weight the 
greater the loss. The loss continues from three to 
six days and then begins a gradual gain. 

It is generally taught that the loss is regained 
in from seven to ten days. This is frequently true 
where the mother has already nursed one or more 
infants, but in the case of a first born the period 
required to regain the loss is usually much longer, 



GROWTH AND DEVELOPMENT 21 

extending from two to three weeks. During this 
time no anxiety need be felt unless the infant con- 
tinues to lose, in which case it must not be weaned 
but given additional food, after each breast feed- 
ing. The amount of food needed can only be de- 
termined by weighing the baby before and after 
each feeding. 

THE NORMAL INFANT 

It is usually not difficult to determine whether 
an infant is physically normal. There are definite 
measurements and other standards to which an in- 
fant must conform in order to be considered nor- 
mal. 

The determination of the nervous and mental 
condition of an infant is, however, much more diffi- 
cult. Even an experienced physician may make 
mistakes. 

It is particularly important in infants for adop- 
tion to ascertain whether there is any serious phys- 
ical or mental defect. 

In order to demonstrate the character of the 
special senses, examinations are made to determine 
the infant's sensibility to certain influences. For 
example, the sensibility of the skin is determined 
by tickling and by touching it with hot and cold 
objects: the hearing, by making a noise such as 



22 INFANCY AND CHILDHOOD 

the ringing of a bell; the sight, by bringing bright 
objects before the eyes and watching to see if they 
follow them. 

It is difficult, or even impossible, to determine 
the mental development of infants before the fifth 
or sixth month. 

NATURAL MOVEMENTS OF THE BODY 

The natural movements of a normal infant are 
characteristic and by close observation much infor- 
mation may be secured. 

The impulsive movements of the hands, feet and 
legs, as well as those of crying and laughing, are 
characteristic. 

In contrast to the impulsive movements are the 
reflexive movements or those which arise from irri- 
tation; for example, the contraction of the pupils 
to light, swallowing, sneezing, or yawning. To re- 
flexive movements are added other instinctive ac- 
tions, such as sucking and sticking the fingers in the 
mouth. 

SUCKING THE FINGERS 

The sucking of the fingers is not necessarily indic- 
ative of hunger but is an instinctive impulse. 

The movements of the infant which are at first 
involuntary gradually become voluntary. The im- 
pulsive movements become less frequent and the 



GROWTH AND DEVELOPMENT 23 

reflexive movements much more frequent. The 
movements of expression, as laughing and crying, 
will depend more upon how the child feels, whether 
it is happy or whether it approves or disapproves. 

Movements of the head after the third month 
are voluntary. From then on the child learns more 
complicated movements and combines these with 
the will, so that in time it walks, observes what is 
done by others, talks, etc. 

Mental Development. "At the third to 
fourth month an infant begins to follow objects 
with the eyes; at four to seven months it begins 
to take an interest in its surroundings, laughs, 
plays with its toys and begins to assume some of the 
character of an individual." At about eleven to 
twelve months the child will stand by taking hold 
of chairs and other objects, and by the thirteenth 
to the sixteenth month it will usually begin to walk 
alone. {See illustration facing page 42.) 

Rickets as Cause of Delayed Development. 
The normal time for the development of all the 
above mentioned functions is impeded in the case 
of premature infants, constitutional weakness, long 
illness and malnutrition from any cause. Rickets 
is one of the common causes for delayed physical 
development. 

The different appliances for teaching children to 
walk are rarely to be advised. 



24 INFANCY AND CHILDHOOD 

DEVELOPMENT OF THE SPECIAL SENSES 

Instinct. Instinct in the new born is much 
less developed in the infant than in the young ani- 
mal. The young infant must therefore be much 
longer protected than any other animal. The 
senses of hunger, thirst, fatigue are early developed 
in the infant, as evidenced by crying and the per- 
fect contentment which follows when hunger and 
thirst are appeased. 

Taste and Smell. The sense of smell is but 
little developed in the new born, but is present to 
some extent even at birth. The sense of taste is 
already fairly well developed in the baby and by 
certain grimaces he makes his distaste known. 

The sense of like and dislike in many children 
however only appear by rather extreme irritation. 

Development of Hearing. Directly after birth 
all infants are deaf, as the organs of hearing only 
begin to functionate after the eustachian tubes, 
which lead from the throat to the middle ear, be- 
come free from secretion and are well inflated with 
air. This occurs within the first few days. 

In the first few weeks, although the infant can 
hear, it is not sensitive to sound and reacts but 
little. 

Sight. The same is true of the sense of sight, 
for although the pupils react to light the infant 



GROWTH AXD DEVELOPMENT 25 

shows no evidence of being conscious of seeing the 
light. 

Movements of Eyes. In the new born the 
eyes do not coordinate, that is. act together. For 
example., one eye may be open while the other is 
closed, or one eye may be moved while the other 
remains still, there may be a distinct squint. The 
eyes move together when the child develops the 
power of fixation (about the fourth month). 

It is important that the mother understand the 
relative times for the development of the different 

ses: otherwise she is likely to worry, much : 
her own and the infant's detriment. 

Talking. There is a great difference even in 
normal children in their ability to talk. h.:s: 
children at twelve months are able to say, " Papa/' 
" Mamma," and to form short sentences at the end 
of the second year. Xot infrequently, however, chil- 
dren who understand perfectly do not form words or 

(fences until two and a half or three years. If 
they are not deaf, and if the understanding is good, 
no concern need be felt. The fact that a child is 
fluent at two years does not necessarily imply better 
brain power than one whose oratorical powers are 
less developed. 

The development of speech, with the exception 
of a few words learned mechanically, is preceded 
by an understanding of the speech. The speech 



26 INFANCY AND CHILDHOOD 

center in the brain is very slow to develop in some 
children and very rapid in others. 

When a child at two years makes no effort at 
forming words, the advice of a competent physician 
should always be sought to determine the possibility 
of deaf-mutism. Deafness can usually be detected 
as early as the sixth or eighth month. 

Coordination of Muscles. If a child does not 
take things in its hands and stick them in its mouth 
when it is five or six months old, or if in attempting 
to grasp objects it does so with fingers extended and 
only closes its hands with difficulty and with in- 
coordinate movements approaches the mouth, it 
should be at once examined by a physician as it is 
probable that the child is suffering from an affection 
of the nervous system. 

Test to Determine the Mental Development. 
In determining the mental development of children 
after one year the Kuhlman modification of the 
Binet-Simon system * will be found useful in 
skilled hands. 

THE MENTAL AND MORAL DEVELOPMENT OF 
THE CHILD. "HOME TRAINING " 

The importance of " home training " in the 
minds of parents depends upon the extent of their 

1 A Review of the Binet-Simon System for Measuring the 
Intelligence of Children, by F. Kuhlman, Director of Physi- 
ological Research, School for Feeble-minded, Faribault, Minn. 



GROWTH AND DEVELOPMENT 2*7 

belief in heredity. The less importance they at- 
tach to heredity the greater is their responsibility. 
Parents are prone to attribute all the good traits 
in their children to their own efforts, and all the 
bad ones to heredity, coming of course from the 
other side of the house. 

It is the opinion of most authorities on children 
that in the great majority of cases, where a child 
is unruly, has an uncontrollable temper and other 
bad traits, the difficulty is more with the " training " 
than with heredity. " With the exception of chil- 
dren actually suffering from an abnormal condition, 
there are no defective children, only defective con- 
ditions." 

" The moral and mental makeup of the indi- 
vidual, his nature and character, is partly inherited 
and partly developed. Therefore the part which 
inheritance and development plays in the moral and 
mental influence is of widely different importance. 
Temperament, for example, is an inherited posses- 
sion, the over or under development of which may 
through the development of self-control be much 
restricted, the temperament, however, remaining the 
same through life." 

" The intelligence is also inherited, and through 
the influence of the home and the school may be 
brought to a much higher point of development, 
but it is from the beginning there and will scarcely 



28 INFANCY AND CHILDHOOD 

be fundamentally changed by any influence. That 
knowledge and capability, during the whole life- 
time, may be developed and increased, and that the 
will to work, the pleasure taken in the work, may 
be influenced by training, has been positively demon- 
strated." On the other hand, the training has a 
much greater influence on the character than on the 
intelligence and temperament, especially during the 
first years of life. 

" The first five years are the most important for 
the development of the character of the indi- 
vidual. The later influences do no more than de- 
velop the already sprouting seed." 

The literature * of the past few years is rich in 
books concerning the rearing of children, their phys- 
ical, mental and moral development. 

The question arises, at what age we may begin 
to teach a child, or, in other words, begin its edu- 
cation ? 

Education and Memory. The education may 
begin as soon as the mind is sufficiently developed 
to hold impressions and long before the intelligence 

1 Harrison, Elizabeth — The Study of Child Nature; Froe- 
bel — The Education of Man; Montessori — The Montessori 
Method; Hall, G. Stanley — Youth; Addams, J. — The Spirit 
of Youth and the City Streets; Adler, Felix — Moral Instruc- 
tion of Children; James — Talks on Psychology and Life's 
Ideals; Henderson, C. Hanford — What it is to be Educated; 
Conklin, Edward — Heredity and Environment; Galloway, 
Thos. Walton — Biology of Sex for Parents and Teachers; 
Ellis, Havelock — The Task of Social Hygiene. 



GROWTH AND DEVELOPMENT 29 

is sufficiently developed to determine cause and 
effect. 

The memory is, however, very early devel- 
oped. This may be demonstrated by the way in 
which the very young infant may be taught regu- 
larity. For example, the regularity with which in- 
fants awake for their meals and the ease with 
which with some persistency these hours may be 
changed. 

We now know that each child is born with its 
limitations and possibilities. We do not know, 
however, what these possibilities and limitations 
are. Therefore, it is the duty of parents and the 
State to encourage the fullest development possible 
in each child. This development should be con- 
sidered as three-fold: physical, mental, and moral, 
and also in its relation to society as well as the in- 
dividual child. 

Many of the difficulties in the way of mental and 
moral growth are effects of improper diet, insuffi- 
cient sleep, and too little exercise in the open air. 
Many, on the other hand, are directly consequent 
upon improper direction and discipline. If par- 
ents, fathers as well as mothers, could be made to 
realize the importance of the first five years of the 
child's life in the formation of such habits as con- 
centration, observation, and self-control, and the 
importance of well thought out ideas toward which 



30 INFANCY AND CHILDHOOD 

to aim, the question of discipline, with the direct- 
ing of work and play and the necessary correction, 
would not be simply one of moods on the part of 
those in authority, as is so often the case. Regard- 
ing the mental development, three important points 
should be emphasized: concentration, observation, 
and the training of the imagination. One of the 
best and simplest means of teaching children to ob- 
serve and concentrate is through the study of na- 
ture. This study should be encouraged early, so 
that these simple, healthful pleasures may develop 
into real resources for later life. Another of the 
simple ways to develop concentration and observa- 
tion is through the analysis of good pictures. Par- 
ents who encourage or allow their children to go 
from one thing to another aimlessly, without finish- 
ing anything begun, or to take over long to perform 
the simple duties required of them, are weakening 
their powers of concentration, which are so inval- 
uable in their school work and later occupations. 
Some children, through constant diverting on the 
part of the parents, lose what natural concentration 
they have. It is well to supervise and direct work 
and play to definite ends and to encourage children 
to carry out their ideas. But, on the other hand, 
when children are legitimately occupied and happy, 
they should not be interrupted more than is neces- 
sary. The aimless standing or walking around the 




Outdoor Activities Which Keep Children Healthy 



GROWTH AND DEVELOPMENT 31 

streets that so many of the well-to-do children are 
allowed to indulge in, does not prepare them for 
definiteness of purpose later on. If a walk is to 
be taken, let a definite objective point be chosen. 
When a child goes out to play, let it be encouraged 
to plan what it is to do. Toys such as blocks for 
building bridges and houses, modeling clay, draw- 
ing and sewing cards, are excellent for the in-door 
occupation of smaller children, with tools and books 
for older ones; for out-of-doors, sand-piles, wagons, 
barrows, balls, etc., and later, gardens. Children 
who are taught early to dress and undress, help in 
passing things, and run errands, are being trained in 
concentration and observation. 

In regard to the imagination, it is usually a ques- 
tion of stimulating it or holding it in check. Cer- 
tainly, a ready imagination means a quicker 
appreciation of another's point of view and greater 
sympathy with all conditions of society. It means 
that we are less dependent for our happiness on 
our material well-being. It means greater re- 
sourcefulness in work and play. It means that city 
children, by the happy art of " make-believe/ ' can 
have dogs and ponies, and even the wild animals 
of the forest, as their companions, with no expense 
and no trouble with the neighbors. They can be 
kings and queens, with palaces in their sand-piles 
and dolls as subjects, or dream of distant lands to 



32 INFANCY AND CHILDHOOD 

conquer from the top of the old apple-tree. To 
play games with the wind or a shadow is often the 
first step toward a later faith in the unseen forces 
of the world. On the other hand, an over-devel- 
oped imagination may lead to an unstable nervous 
system. 

In the moral sphere there is no more important 
point than that of self-control. When we consider 
all that self-control may mean to the child, to the 
adult, and to society, too great emphasis cannot be 
laid upon its training to that end. Beginning with 
the first week in infancy, when the baby cries to 
be taken up when taking-up is not good for it, self- 
control may be taught in many simple ways, but 
to be a structure which will endure, it must be built 
upon a firm foundation of good inheritance and 
health and grow slowly from day to day through 
training in matters in themselves small, but on the 
whole, in the light of the future, of tremendous im- 
portance. 

One simple way of teaching self-control, from 
early childhood on, is not to remove objects about 
the room, or at the table, but train the child to let 
them alone. Grown people should not be deprived 
of things because children are present. Children 
should not think they have to have everything adults 
do. One small child of my acquaintance feels that 
his share in a box of candy, is passing it to others. 



GROWTH AND DEVELOPMENT 33 

Children have learned a valuable lesson in self-con- 
trol when they have learned to eat what is put be- 
fore them without crying because they cannot have 
what is served to others. 

In close relation to the question of self-control 
comes that of cheerfulness, unselfishness, and 
courtesy towards other members of the family and 
playmates. Taking the family as a unit of society, 
how important it is that a child learn how to be 
fair to those with whom he comes in daily contact. 
Loyalty and devotion to the family is the corner- 
stone of loyalty and devotion to the nation. A 
parent's attitude towards servants of the household 
is very important. If a child can be made to realize 
the value of the work of the gardener or house serv- 
ant in the sum total of all labor, how much easier 
does the training in courtesy and consideration be- 
come. If a child is required to clean up the litter 
made from cutting paper, for instance, or put away 
his playthings, how much more does he appreciate 
the work of those who do that as a routine. A 
child should be given responsibility early. Let him 
have some duty to perform regularly, such as filling 
the bird-bath or weeding the garden. 

In regard to truth-telling, there is no better 
teacher than good example. How can a child 
value the truth when parents and nurses deceive 
him constantly and tell what may be called u white 



34 INFANCY AND CHILDHOOD 

lies " with no apologies ! When children ask ques- 
tions, how many of them get an honest attempt at 
the truth! The question of sex teaching suggests 
itself in this connection. Children believing in 
their parents ask questions regarding the funda- 
mentals of life. Should their parents, cowardly or 
indifferently, shirk the great privilege of responding 
to this trust? 

Boast fulness in children should be discouraged, 
as it obscures the truth, and through it children 
grow in the practice of deceiving their companions 
and themselves, enjoying the commendation re- 
ceived even when undeserved. 

It is to be urged that those in authority over chil- 
dren have ideals, and after making a very early 
beginning persevere in the attempt to work them 
out, directing and correcting wisely, not as though 
the days had no relation to one another, and that 
a feeling of irritability w r ere sufficient to dictate the 
kind of treatment to be meted out. Let the ex- 
amples of the parents be worthy ones to follow, 
first of all, and then unite with the love and under- 
standing which a study of the individual child has 
given, a dignified firmness in enforcing obedience. 
Since much of life is necessarily a subordination of 
one's will to higher authority, the consequent re- 
lationship of child and parent is only the first lesson. 

Parents should realize that most normal, healthy 




* In the Country There Is Always Something to Interest 
and Instruct the Child" 



GROWTH AND DEVELOPMENT 35 

children are active and energetic and need outlets 
for their energy. In the country where there are 
animals to feed and crops to be planted and gath- 
ered, there is always something to interest and in- 
struct the child, but in the city places for play and 
things to play with should be provided. The poorer 
children are being taken care of in the public play- 
grounds under trained supervisors, but are the chil- 
dren of the well-to-do? Children should have the 
companionship of their mothers and fathers on 
walks and picnics in the woods, which are the parks 
of rich and poor alike. If more fathers realized 
the right of their children to this companionship, 
they would not so often be mere fountains of ma- 
terial blessings, but there would be a real sympathy 
making necessary discipline easier for all. 

The first point to emphasize in the consideration 
of discipline is that the child should not be nagged 
all the time, but after a wish or command has been 
expressed it should be obeyed whenever and wher- 
ever made. A parent or person in authority must 
have absolute confidence in himself, confidence that 
the child will obey. The parent w T ho feels help- 
less in the hands of his child and doubts himself 
might as well not attempt to discipline. A child 
should not be allowed the center of the stage nor to 
interrupt conversation any more than should a 
grown person. If children are allowed to show off 



36 INFANCY AND CHILDHOOD 

it develops in them not a love of accomplishment 
but of applause. 

In the matter of punishment and rewards there 
is a great difference of opinion. I believe many 
little things should be ignored as passing phases, 
since too frequent punishment loses in effectiveness. 
After a child is old enough to be reasoned with, 
such punishments as sending him to his room, stand- 
ing him in a corner, or depriving him of some play- 
thing, or prospective pleasure, are often more ef- 
fective than corporal punishment. Children should 
learn early not that good deeds are always rewarded 
materially, but that misbehavior means unhappi- 
ness either to themselves or some one else. 



Ill 

THE NURSE 

To be successful in the handling of children 
the nurse must first of all love children and besides 
this must have special qualifications fitting her for 
one of the most important duties which fall to any 
individual. 

She must be intelligent, and a keen observer. 
She must have an even temper and have endless 
patience. She must be firm and kind. She must 
be content with observing the results of her work 
without receiving much applause. 

Every action of a child is worth observing, es- 
pecially during sickness. Since an infant cannot 
talk, all information must be gotten from observa- 
tion. Frequently much more information may be 
derived when the child is alone with the nurse, or 
the mother, or when it is asleep, than when the 
physician is making his visit. 

The child in reality speaks a very definite lan- 
guage, the correct interpretation of which requires 
careful study. For example, the writer saw a 
beautiful child die, during the hot weather, as a 

37 



38 INFANCY AND CHILDHOOD 

result of an improper interpretation of its language. 
The baby cried much after feeding and the nurse, 
taking the cry to mean " hunger/' gave the infant 
food as often as it cried. For several weeks there 
had been frequent bowel movements which were at 
first normal in color, but gradually became green 
and watery. Had the nurse interpreted properly 
the child's language she would have known that the 
cry did not mean hunger but indigestion. She 
should have known this from the frequency and 
character of the movements and should have 
diminished the quantity of food and increased the 
intervals between feedings, or if there were any 
doubt as to the proper course to pursue, consulted 
the physician in charge. 

Besides having natural qualifications, a nurse 
should have special training. There are now in- 
stitutions in every city, directed to the special care 
of children, where such training may be secured. 
Courses for nursemaids in the care and feeding of 
children, extending over a period of six months, 
are now given in connection with many of the child 
welfare clinics. 



IV 

CARE OF THE NEW BORN 

The nurse assumes the care of the infant as soon 
as the cord has been tied, and from that time on its 
welfare is largely in her hands. 

Her first duty is to see that the baby is wrapped 
in warm blankets and placed out of " harm's way," 
in a well ventilated room, where the temperature 
is between 70 and 8o° F. [See Frontispiece.] 
Great care should be exercised in the use of the hot- 
water bottle, as frequently serious or even fatal 
burns occur in this way. 

Tying the Cord. The cord should be carefully 
watched for bleeding during the first twenty-four 
hours, and in case any hemorrhage occurs the 
physician should be notified at once. If he is not 
at hand, in case the bleeding is at all active, the cord 
should be retied with a good stout silk ligature 
which has first been boiled. 

Care of the Cord. The subsequent care of the 
cord is of the utmost importance. 

Whatever method is employed by the physician 
in charge, the ultimate object is to keep the cord 

39 



40 INFANCY AND CHILDHOOD 

free from infection and at the same time to have it 
dry up, (mumify) so that it will separate from the 
body as soon as possible. The cord normally 
" falls off " in a week or ten days. 

As a dressing for the cord some powder, such 
as bismuth subnitrate or starch which has been 
sterilized by baking, is to be recommended. This 
powder is dusted on sterilized gauze and the cord 
enveloped therein. 

Care of the Navel. // at any time the skin 
around the navel should become inflamed the phy- 
sician should be informed at once, as an infection 
of the navel may be a matter of the utmost gravity. 

After the cord has been separated the raw sur- 
face may be sponged once daily with a normal salt 
solution (teaspoon salt to pint boiled water), or a 
50% alcohol solution, after which it is to be cov- 
ered with sterile gauze. 

HERNIA (RUPTURE) 

Rupture or nonclosure of the abdominal wall at 
the navel is a very common affection and may 
usually be prevented if the proper precautions are 
observed by the nurse. 

Binders. Even before the cord has separated 
a "snug" (not tight) binder should be applied; 
this should be worn until the navel is healed. It 
should then be discarded. 




The Correct Treatment of Abdominal Hernia 



CARE OF THE NEW BORN 41 

Influence of Crying. Prolonged crying, be- 
fore the umbilical opening has healed, may result 
in rupture. 

Application of Adhesive Straps. A strip of 
surgeon's plaster (oxide of zinc) two inches wide 
and six inches long applied across the abdomen over 
the navel, so as to hold the edges of the opening 
firmly together, frequently results in a " cure." 
The objection to this form of support is that great 
care must be exercised so that the plaster does not 
become wet, otherwise it will not adhere. Another 
objection to the plaster is that the skin after a short 
time becomes irritated so that for a time its use 
may have to be discontinued. These " adhesive 
straps " should be removed by sponging with ben- 
zine, and after the skin is clean and dry a new strip 
of plaster should be at once applied. To apply this 
strip properly an assistant is necessary. It must be 
worn for several months at least and long after any 
evidence of the hernial opening has ceased to exist. 

The classical " button " as a cure for umbilical 
hernia is worse than nothing and should never be 
used. 

Yarn Trusses: for Hernia in the Groin. In 
the treatment for hernia in the groin in infants and 
young children trusses of soft yarn are often suffi- 
cient if properly and persistently applied. 



42 INFANCY AND CHILDHOOD 

BATHING 

No bath need be given for the first few hours 
after birth. The infant should, however, be 
anointed with warm oil in order to soften the 
cheesy material (Vernix Caseosa) with which the 
skin is usually covered, and the first warm sponge 
bath given after 12-24 hours. 

Temperature of Bath. During the first month 
only sponge baths should be given, and these only 
in a room where the temperature is above 75° F. 
The baby should be covered with a warm blanket 
and only a portion of the body exposed at one time. 
The temperature of the water should be 95-100° F. 
for the first few weeks, after that slightly cooler. 
Tub baths may be given to rugged infants after the 
first month or two, provided the temperature of the 
room and water are properly maintained. 

Exposure to Cold. It must be remembered 
that young infants do not stand exposure to cold at 
all well, they lose heat rapidly, with resulting low- 
ered vitality and consequent bronchial and diges- 
tive disturbances. Cold baths should never be given 
to young children. Such a practice has no prece- 
dent in nature, neither among aboriginal races nor 
animals. We will do well not to try to improve 
too much upon nature. 

Influence of Soap on Skin. If any soap is 




The Skull of an Infant 
Showing Sutures and 
Fontanels 

[Page 3.] 




At Eleven to Twelve 
Months the Child Will 
Stand by Taking Hold 
of Things " [Page 23.J 




Folding Bath-Tub 



CARE OF THE NEW BORN 43 

used it should be of the best quality, since many 
cheap soaps contain free alkali in such quantity as 
to be extremely irritating to the skin, not infre- 
quently producing an eruption. 

CARE OF THE SKIN 

The skin of the new baby should be dried with 
a soft towel by sponging, not by rubbing, as the 
latter is a frequent source of irritation. After six 
months, in vigorous infants, the temperature of the 
water may be reduced to 8o° F. or even less and 
some friction used so that the skin is made to 
glow. In older infants the face and neck should 
be sponged with cool water, since these parts 
are always more or less exposed to the atmos- 
phere. 

Skin Irritation. The skin soiled from the dis- 
charges from the bowel and bladder should be 
sponged off with warm water or oil every time the 
diaper is changed; otherwise it will become in- 
flamed. When some degree of irritation is present 
an ointment, such as zinc oxide, should be smeared 
over the cleaned surface in order to protect the skin 
from further contact with the discharges. 

Care of Skin Around the Genitals. Great care 
should be exercised in cleansing the skin around the 
genitals after a bowel movement, especially in fe- 
male infants, since it is not improbable that many 



44 INFANCY AND CHILDHOOD 

cases of bladder infection result from contamina- 
tion about the vulva. A pledget of cotton dipped in 
clean water should be used to cleanse the vulva, 
wiping from before backward. Each cleansing 
will therefore require several pledgets. 

Wash Cloths. Wash cloths should never be 
used more than once without being washed and 
boiled. Soiled washcloths may readily be a source 
of infection to the eyes and genital organs. 

CARE OF THE GENITAL ORGANS 

The Female. The genital organs of the fe- 
male infant should be cleansed daily by sponging 
with warm water to which some borax may be 
added. All secretions should be removed from the 
folds and the surface dried by careful sponging with 
some soft material. No powder such as talcum 
should be used directly in or around the vulva. Such 
powder acts as a foreign body and serves only to 
produce irritation. If some irritation of the mucous 
membrane is present, absolute cleanliness is the best 
remedy, and if any application is made it should be 
in the form of a simple emolient, such as zinc oint- 
ment or vaseline., Not infrequently a concentrated 
urine, due to improper food or insufficient water, 
is the cause of the irritation. 

The Male. It is in the care of the genital or- 
gans of the male infant that the greatest diversity 



CARE OF THE NEW BORN 45 

of opinion exists. Practically all male infants have 
an adherent foreskin at birth. 

Circumcision. The question is what should 
be done with this adherent foreskin? Should it be 
left alone, or shall stretching or circumcision be 
performed? The fact is that if left alone about 
one-third to one-half of the cases will correct them- 
selves after a few months. The remaining cases 
should be corrected either by stretching, or, where 
the foreskin is very long, by circumcision. These 
questions must be left to the decision of a phy- 
sician. Where there is a great amount of secre- 
tion around the glands, and where after one year 
it is found that it is difficult to keep the parts clean, 
then circumcision should be performed. I am con- 
vinced from long observation that altogether too 
much attention is directed to the genital organs in 
infants and young children. It is hard to conceive 
that nature should have made such a serious mis- 
take as many people would have us believe. 

It is usually sufficient to keep the genital organs 
of both sexes clean, and if any irritation or inflam- 
mation is found to be present, then the physician's 
attention should be called to the condition. 

CARE OF THE EYES OF THE NEW BORN 

Eye Infection Treatment. It is a well known 
fact that 80-90 per cent, of the cases of blindness 



46 INFANCY AND CHILDHOOD 

are traceable to infections received from the secre- 
tions of the mother at the time of birth. Any puru- 
lent vaginal discharge from which the mother may 
be suffering at the time of the birth of the child is 
very liable to infect the eyes of the infant. There 
is one form of infection (gonorrhea) which is es- 
pecially liable to produce blindness. Since it is im- 
possible without a microscopic examination to rule 
out this infection, all suspicious cases should be 
treated at once by dropping a solution of nitrate 
of silver into the eyes. This should always be done 
under the direction of a physician. In some States 
this treatment is compulsory in all cases, and many 
physicians make it a routine. 

In my opinion, in all cases, the eyes of the new 
born should be washed with a solution of warm 
Boric Acid and a 15 per cent, solution of Argyrol 
dropped in. This treatment should be repeated at 
least three times daily for several days. If there 
is the least trace of pus present, or if the eyelids 
are stuck together in the morning, the condition 
should be at once reported to the physician. A cul- 
ture should be taken and the exact character of the 
infection determined. 

CARE OF THE MOUTH 

Swabbing. The mouth of the healthy infant 
rarely needs cleansing. Directly after birth if there 



CARE OF THE NEW BORN 47 

is much mucus in the mouth or throat it should be 
wiped out. This, however, should be done with 
the greatest care; otherwise serious injury to the 
mucous membrane may result. The system gener- 
ally practiced of forcibly swabbing out the mouth 
daily one or more times with the index finger, over 
which a piece of gauze has been stretched, is respon- 
sible for many of the sore mouths in infants. 

Wherever the delicate epithelial covering of the 
mouth is brushed off, a white spot results. The 
secretions keep the mucous membrane of the mouth 
clean, and it is only when teeth appear that the 
mouth needs care, unless some infection has already 
occurred. The infected spots should be gently 
sponged with some mild alkaline and antiseptic solu- 
tion, such as boroglyceride. 

CLOTHING OF YOUNG INFANTS 

Exposure to Heat and Cold. The question of 
clothing must of course differ with the character 
of the climate and with the kind, and degree of heat 
in the home. The important thing is that the body 
of the infant be so protected by clothing, that it 
will be at no time exposed to degrees of cold or 
heat to which it cannot accommodate itself. Young 
infants do not stand exposure to cold well, they 
lose heat rapidly and are liable to suffer from some 
acute catarrhal condition as a result. Neither do 



48 INFANCY AND CHILDHOOD 

they stand prolonged high temperature well. It is 
important therefore that the amount of clothing 
should vary with the temperature. The skin 
should be kept comfortable. During the winter in 
the northern climate, woolens should be worn, the 
amount to be determined by the temperature of the 
atmosphere. 

In extremely hot weather in summer much, and 
sometimes practically all, clothing should be re- 
moved. 

Prickly Heat. An extremely irritating rash, 
known as " prickly heat/' frequently results from 
too much clothing in hot weather. 

Care must be exercised, since, in this climate par- 
ticularly, sudden changes of the weather are apt 
to occur, and with a descending thermometer, cloth- 
ing should be gradually added. 

Not infrequently the most serious intestinal dis- 
turbances occur in infants not during the hottest 
weather, but directly after a sudden drop in the 
thermometer. 

LIST OF CLOTHING FOR NEW-BORN BABY 

Three flannel binders (one-half yard of twenty- 
seven inch flannel). 

Three shirts, wool and silk, or wool and cotton. 

Two flannel petticoats. 

Two flannel or knitted sacques. 



CARE OF THE NEW BORN 49 

Two pairs of worsted socks. 

Two dozen diapers, twenty-two by forty- four 
inches. 

One dozen diapers, twenty-five by fifty inches. 

Four white muslin slips. 

One cloak. 

One warm cap. 

One pair of mittens. 

One veil. 

Two blankets. 

One box talcum powder. 

Two dozen safety-pins, large and small. 

Two bath towels. 

Two soft towels. 

Later — Three pairs of woolen stockings. 

Three knitted bands with shoulder straps. 

Additional diapers. 

(Supplement No. 10 U. S. Public Health Re- 
ports.) 

The flannel binder, four to six inches wide, should 
be worn snugly, not tightly, around the abdomen, 
until the navel is healed. This should be so applied 
as to approximate the edges of the umbilical open- 
ing. The woolen shirt in warm weather should be 
of the lightest weight. 

When extra clothing is needed at night, or when 
the child is out of doors, it may be added in the 
form of coats, blankets, robes, etc. 



50 INFANCY AND CHILDHOOD 

The amount of clothing should only be sufficient 
to keep the skin comfortable. If the skin perspires, 
some clothing should be removed. If the baby per- 
spires when asleep, it is either too warm or suffering 
from rickets or malnutrition. 




Handy Folding Table for Bathing and Dressing the Baby 

All clothing should be so arranged as not to in- 
terfere with the free movements of the body. In 
older children all clothing should be suspended as 
far as possible from the shoulders. (See page 

179.) 

Effects of Tight Clothing. Too tight clothing 
around the chest interferes with breathing. A 
tight band around the abdomen is a frequent cause 
of regurgitation of food, and in addition is a pos- 
sible factor in the production of ruptures in the 
groin. 

Freedom of Motion. The hands and feet 
should be allowed unrestricted movement, since it 



CARE OF THE NEW BORN 51 

is only in this way that the baby gets the exercise 
it needs for proper development. 

DIAPERS 

Diapers should be of soft non-irritating material 
which will readily absorb moisture (cotton). 
They should be loosely applied so that the infant 
has freedom of movements and is comfortable. 

Soiled Diapers a Cause of Bladder Infection. 
Diapers should be changed as soon as soiled. 
Soiled diapers are always a source of discomfort 
and not infrequently the cause of severe irritations 
of the skin, as well as of infections of the genital 
and urinary tracts. This is especially true in the 
case of female infants. 

No diaper should be applied a second time with- 
out first being washed. 

All diapers which have been soiled by discharges 
from the bowel should be first washed and then 
boiled and thoroughly dried before being used. 

Danger of Safety Pins. The use of pins is 
frequently a source of great discomfort to infants. 
It is not uncommon that in fastening diapers safety- 
pins include the skin also, and the writer has on two 
occasions seen the scrotum pierced. When chil- 
dren shriek as if with pain it is always well to ex- 
plore the skin under the diaper. 

"Vanta Garments/' including diapers, are now 



'52 INFANCY AND CHILDHOOD 

procurable fastened with tape, no pins being neces- 
sary. They may be purchased at any general store. 

THE NURSERY 

The following requirements are essential for an 
ideal nursery : 

Sunshine. First, the room should be of good 
size, with plenty of light, the windows being so lo- 
cated that it has sunshine a part of the day at least, 
the year around. 

Fireplace. A fireplace is an excellent adjunct 
and serves not only to heat the room at special 
times, but also as a means of ventilation. 

The windows should be furnished with dark 
shades and no other hangings should be allowed in 
the room, as they simply serve to collect dust. 

Fresh Air. Open Windows. The air should 
be kept constantly fresh by means of some aperture 
communicating with the outside. It is sufficient 
if a window is left slightly open, preferably both 
at the top and bottom, for by this means there is a 
constant rotary motion of the air around the win- 
dow which serves to keep the air fresh. A screen 
placed before the window will prevent the air from 
blowing directly across the room. It is not suffi- 
cient to have the windows of a nursery opened once 
or twice daily for a few T minutes, as the air quickly 
becomes foul again. 



CARE OF THE NEW BORN 53 

Number of Persons at One Time in Room. 
No more than one person should be in the nursery 
at one time with an infant, and during its sleeping 
hours it should be alone. 

Temperature of Nursery. The temperature 
of the nursery for an infant during the first few 
months should be 70° F. during the day and during 
the night slightly lower. After six months it may 




A Knitted Hammock for the Baby 

be allowed to go as low as 50 F. if the infant is 
rugged and has no catarrhal conditions of the 
respiratory tract. 

Zero temperatures are to be avoided in young 
children. The less the extremes of heat or cold to 
which the mucous membranes of "infants are ex- 
posed the less liable they are to suffer from catarrhal 
conditions of the respiratory tract. 



54 INFANCY AND CHILDHOOD 

Fresh Air and Cold Air. It must be remem- 
bered that what is needed is fresh moist air and not 
cold air, and that it is not necessary that air be cold 
in order that it be fresh. 

Lighting of the Nursery. A nursery should 
never contain a gas jet; it is always liable to leak 
sufficiently to be a source of contamination to the 
air. A lamp or jet should never be permitted to 
burn for hours at a time in a nursery. Where 
electric lights are not available, a small wax candle 
will suffice and will use up a minimum of oxygen. 

AIRING OUT OF DOORS 

Where the conditions at home are at all ideal 
it is not necessary nor advisable that an infant be 
taken on the street for any airing. When a house 
has a number of windows through which the sun 
shines, or in addition a well situated porch, an in- 
fant can get just as much and as good air at home 
as it can anywhere. 

The Perambulator. Kissing. Wheeling the 
baby about the street has nothing to commend it 
and has the disadvantage of exposing the infant 
to being picked up and kissed by every admiring 
friend the mother happens to meet, with the added 
danger of contracting some form of contagion by 
the way. 

Shade. During the hot weather it is fre- 





A Child Should Have Much Exercise in the Open Air, 
Both Summer and Winter 

\Pages 56 and 123.] 



CARE OF THE NEW BORX 55 

quently cooler on the shady side of the house with 
the windows open than it is out of doors. When 
the quarters are small and it is impossible to keep 
the room cool, the baby should be taken into the 
open air, on the shady side of some building, in an 
open shady grass plot under the trees, or in the pub- 
lic parks. 

SLEEP 

A new born baby should sleep practically all of 
the time except when it is nursing. From six 
months to a year an infant should sleep about two- 
thirds of the time. Up to the age of six years a 
child should sleep fully one-half of the time. 

An infant should never sleep with the mother or 
nurse. It should be given its food and put in 
its own bed, and preferably in its own room. 

After six months a baby may go all night, from 
6 p.m. to 6 a.m., without a feeding. It is, how- 
ever, rather unusual that a baby will go so long 
without food. It is therefore usually better to give 
a feeding at ten o'clock. If a baby wakes up again 
in the night it should never be taken up unless to 
change its diaper, but should be given a little water 
(no food) and never carried about. The habit of 
taking up a crying baby at night, except for reasons 
given above, is fatal to the comfort of the household 
and bad for the baby itself. 

After two years many children sleep too much. 



56 INFANCY AND CHILDHOOD 

A child who sleeps all night, from 6 p.m to 6 a.m., 
and takes a nap of one or two hours during the day, 
should spend the rest of the time out of doors, in 
reasonable weather. 

Effects of Exercise. In order that a child 
shall develop properly physically and mentally it 
must have much exercise in the open air. 

A child who has insufficient exercise will not 
sleep quietly; it takes its food without relish and 
does not assimilate well what it does take. 

The habit of taking a nap in the middle of the 
day should be insisted upon until the fifth or sixth 
year and as much longer as possible. 

Restlessness During Sleep. Restlessness dur- 
ing sleep is due to a number of causes : underfeed- 
ing, overfeeding, adenoids, soiled diapers, illness 
(fever), rickets, too much clothing, or to the child's 
having been spoiled by being carried about or 
rocked. 

TEMPERATURE 

The normal temperature of the baby is 98%° 
F. A slight variation of y 2 ° either above or be- 
low does not mean anything. An infant's tempera- 
ture should always be taken by rectum, as a tem- 
perature taken in the groin, or under the arm, is 
liable to be incorrect. It happens not infrequently, 
if the skin is moist, that even with a high fever the 
thermometer will not register. 




Nursery Pen 



[Pages 52 and 122.] 




: In an Open Shady Grass Plot Under the Trees n 

[Page 55.] 



CARE OF THE NEW BORN 



57 



Slight variations of temperature in children 
which are not persistent may be disregarded. 

A persistent temperature, however, of ioi° or 
102° F. always means some systemic disturbance, 
never teeth. 

When a temperature persists after the simple 
remedies have been tried (cathartic and water diet) 
a physician should be consulted. 

PREMATURE INFANTS 

Infants born between the seventh and ninth 
months of intra uterine life are termed premature. 
The chance which these infants have for life and 
proper development depends upon many conditions. 




Simple Incubator for Premature Infants 

A premature infant born of syphilitic parents has 
little chance for life. 

A premature infant born of healthy parents, when 
the weight of the infant at birth exceeds four 



58 INFANCY AND CHILDHOOD 

pounds, has a fairly good chance for life and nor- 
mal development, provided it can be placed in an 
incubator and have breast milk. 

Premature infants who cannot have breast milk 
have a relatively small chance; they sometimes de- 
velop for a few months, but are prone to be carried 
off by some infection. 

To maintain the body heat in premature infants 
they should be placed in an incubator or properly 
prepared basket and the temperature kept uniformly 
between 90 ° to 95 ° F. Fresh air must be con- 
stantly admitted from below. The infant is 
wrapped in cotton wool, not dressed, and 
only taken from the incubator to be fed and 
cleansed. Bathing except for simple clean- 
liness should be dispensed with. The baby 
should be rubbed daily with warm olive oil. 
Many premature infants have insufficient 
strength to take the breast. The milk should 
be removed regularly by expression, or by 
means of a breast pump, and given the in- 
fant with a medicine dropper or Breck 

Breck feeder. It is necessary often to dilute the 
Feeder 

milk at first with boiled water. 

When the mother has insufficient milk a wet 

nurse should be employed. Allowing the w r et 

nurse's baby to nurse the mother regularly for a 

while, will frequently result in a proper flow of milk, 



CARE OF THE NEW BORN '59 

after which the services of the wet nurse may be 
dispensed with. 

The number of feedings and the amount at a 
feeding which a premature infant may have will 
depend upon the individual case. Weak seven- 
month babies will usually take very little at a feed- 
ing Cj/2 to 1 ounce). It may therefore be neces- 
sary to feed them rather often, say every two 
hours for eight to ten feedings in twenty- four 
hours. If the baby takes a good amount at a feed- 
ing it may be fed less often, every three hours, with 
six to seven feedings in the twenty-four hours. If 
the stools are curdy, or green, or if there is vomit- 
ing, the quantity should be diminished or the milk 
diluted. The diet of the nurse should be carefully 
supervised. (See chapter on the Wet Nurse.) 

As the baby approaches full term the surround- 
ing temperature may be gradually reduced, so that 
it may be removed from the incubator and placed in 
a basket, or box, which is properly padded and 
where the body temperature can be easily kept up. 

Where the regular hospital incubator is not ac- 
cessible one may be readily improvised by a good 
mechanic at little expense. The temperature can 
be maintained fairly uniform by means of a hot- 
water coil, or by several hot-water cans which are 
changed at regular intervals. A thermometer 
should always be kept near the baby. 



BREAST FEEDING 

There is but one ideal food for infants, and that 
is mother's milk. 

Reasons for Nursing. The death rate among 
infants who receive breast milk is only one-sixth 
of that of infants fed on the bottle. 

Ninety per cent, of mothers can nurse their babies 
in whole, or in part, for the first few months, and 
many can nurse them wholly, or in part, for the first 
year. 

About the only disease which should prohibit the 
mother from nursing her infant is tuberculosis, in 
which case the continued nursing would be danger- 
ous to both mother and child. 

When for some legitimate reason a mother can- 
not nurse her own baby a wet nurse whenever pos- 
sible should be procured. (Page 70.) 

Some of the common reasons given for not nurs- 
ing a baby are : " There was not enough milk " ; 
" the milk was bad," etc. These are not sufficient 
reasons. The baby should be kept at the breast, 
even if only a small amount of milk is secreted, and 

60 



Breast Feeding — The Proper Position for Nursing the 
Baby 



BREAST FEEDING 61 

the deficiency made up with some other food. Gen- 
erally speaking, there is no such thing as " bad " 
breast milk. 

Loss in Weight During the First Weeks. It 
is a common occurrence, especially with first babies, 
that for the first few weeks there is insufficient 
milk in the breasts. If, however, nursing is per- 
sisted in regularly, the quantity will almost always 
increase. 

Secretion of Milk. In cases where during the 
first week or so there is insufficient milk secreted, 
the baby will lose in weight. This, however, is not 
serious and the weight will usually be rapidly re- 
gained when the secretion of milk is well estab- 
lished. It is during this time that great care must 
be taken not to produce serious digestive dis- 
turbances by over feeding with some artificial food. 
It is usually sufficient for the first few days to give 
in addition to the breast, some boiled water, and 
later, if the breast milk is insufficient, to begin with a 
little cow's milk (not cream) diluted in the propor- 
tion of one part of cow's milk to three parts of 
boiled water. 

Advantages. The advantages of breast feed- 
ing are : 

First : The low death rate. 

Second : The better nutrition of the infant. 

Third : The greater immunity to disease. 



62 INFANCY AND CHILDHOOD 

Fourth: The greater chance of recovery from 
disease. 

Fifth: The greater sympathy which exists be- 
tween mother and child. 

Sixth : The greater economy of time and money 
in nursing an infant compared to feeding it arti- 
ficially. 

Cost of Patent Foods. The average daily cost 
of many of the patent fools is in excess of twenty- 
five cents. 

To successfully nurse her baby the prospective 
mother should consult a physician many months be- 
fore the birth of the infant with the idea of main- 
taining herself in the best possible physical and 
mental condition. The urine should be examined 
at least once monthly during the pregnancy. In 
case of undeveloped nipples much can be done by 
proper manipulation to develop them. 

Colostrum or First Milk. During the first 
twenty- four hours after birth the infant should be 
put to the breast only every six to eight hours, and 
in the interval given a little w r ater with a spoon. 
During the second twenty- four hours the baby may 
be put to the breast every five to six hours. If 
there is much milk in the breasts, which is not the 
rule, great care must be taken or the infant will 
get too much and as a result have an acute indiges- 
tion with vomiting and green watery stools, since 



BREAST FEEDING 63 

the first milk (colostrum) is laxative in character. 

Technique of Nursing. After the third or 
fourth day the infant should be put to the breast 
regularly every three to four hours, but not to ex- 
ceed six times in twenty- four hours. 

It is important during the first week rather to 
underfeed an infant than to overfeed it. 

If it is found that the stools are good in charac- 
ter and the baby seems hungry, then the amount of 
milk allowed may gradually be increased. 

Number of Feedings. Where there is an 
abundant secretion of milk the intervals may be 
four hours with five feedings in the twenty- four 
hours. The important thing is that the baby get 
sufficient food for its needs and that it be given 
at long enough intervals, so that the stomach will 
have a period of rest before the next meal. 

Too frequent nursing is the most common cause 
of colic, vomiting and bad stools in breast-fed in- 
fants, and frequently results in the baby being 
weaned. 

When the breasts are small, as they often are in 
the case of first babies, and insufficient milk is 
secreted, both breasts may be given at each nursing. 
In the case of premature or very weak infants, 
where the capacity for food is very small, the num- 
ber of nursings may be increased to seven or eight 
in the twenty- four hours. 



64 INFANCY AND CHILDHOOD 

Quantity of Milk at a Feeding. The quantity 
of milk taken at a nursing is extremely variable. 
It is not infrequent that at the age of two or three 
weeks the infant will get three to four ounces at the 
early morning nursings, while at the afternoon and 
evening meals it will not exceed one to one and a 
half ounces: 

Variation in Quantity and Quality of Breast 
Milk. Mental Condition of the Mother. There 
is a considerable variation both in the quantity and 
quality of the milk from day to day, depending upon 
the physical and mental condition of the mother, 
character of food, and quantity of fluid taken. It 
is important, therefore, that the mother should lead 
as even an existence as possible during the nursing 
period. She should have plenty of plain food at 
long intervals, plenty of water between meals, and 
uninterrupted sleep at night. 

In order to carry out these demands regular hours 
for nursings, with long periods between, especially 
at night, are absolutely essential. 

The Daily Quantity of Milk Needed by the Average 
Breast Infant During the First Year Is as Fol- 
lows (Camerer) : 

End of first week 291 grams, 9^ ounces 

End of first month 652 grams, 20 ounces 

End of second month 804 grams, 25 ounces 

End of third month 852 grams, 27 ounces 

End of sixth month 1000 grams, 32 ounces 



BREAST FEEDING 



65 



End of eighth month 1000 grams, 32 ounces 

Twelfth month 1000 grams, 32 ounces 

Green Stools. When a baby is gaining in 
weight and has large, curdy stools which are often 
tinged with green, it is usually getting too much 
milk, or sometimes, owing to the 
character of the diet of the mother, 
the milk is too rich in fat. In such 
cases the intervals between feed- 
ings should be lengthened to four 
hours, especially if there is vomit- 
ing, or the quantity of milk allowed 
the infant at each feeding should 
be reduced. If it is found by 
weighing before and after nursings 
that the baby does not get too much 
milk, then the diet of the mother 
should be reduced and she should be enjoined to 
drink large amounts of water between meals and 
take regular exercise in the open air. 

When for some reason the mother must tem- 
porarily stop nursing, milk should either be pumped 
or expressed from the breasts at regular intervals. 
Overfeeding and Underfeeding. Not infre- 
quently infants who are overfed stop gaining in 
weight after a time and do not gain again until the 
amount of food has been properly reduced. 

If a baby does not gain in weight, does not vomit, 




Breast Pump 



66 INFANCY AND CHILDHOOD 

has normal but small stools, it is presumably not 
getting enough to eat. The stools in case of hun- 
ger, however, are frequently green in color, but 
rarely curdy. 

Hours for Nursing. The hours for nursing 
should be definite and the infant wakened if asleep. 
In a short time, if regular hours for feeding are 
adopted, the baby wakes at the proper time. 

Regular hours are better than the haphazard way, 
for several reasons : 

First, the intervals between feedings will be long 
enough for the stomach to empty itself and have a 
period of rest before the next feeding. 

Second, the mother can arrange her household 
duties and have some freedom and recreation with- 
out feeling that she may be neglecting the baby. It 
is important for both mother and infant that the 
mother should have some time each day to spend 
in the open air and for social intercourse. 

When the hours for nursings are irregular the 
mother never knows when she can leave the house 
or when she must be at home, and the result is that 
many babies are weaned who would otherwise be 
kept on the breast. 

Night Nursings. After the sixth month a 
baby who gets a proper amount of food during the 
day may go from 10 p.m. until 6 a.m. without any- 
thing but perhaps a drink of water. 



BREAST FEEDING 67 

Diet of Mother. The diet of the nursing 
mother should consist of good, plain, properly 
cooked, nutritious food. 

Much of the talk about many articles of food, 
such as fruits, making the baby colicky, is rubbish. 
Pickles and highly seasoned foods, including candy 
and pastry, in any amount, should be excluded from 
the diet. The habit of eating many meals daily is 
a mistake. It is much better to eat three good meals 
daily and between to drink plenty of water. It fre- 
quently happens that where the mother " stuffs " 
herself between meals the digestion becomes de- 
ranged and the quantity and quality of the milk is 
seriously affected. 

Overfeeding of Mother. Many times where a 
mother takes great quantities of milk and gruels be- 
tween meals she gives a small amount of milk, 
usually too rich in quality, and gains rapidly in 
weight herself. 

Before early weaning a baby always consult a 
physician, as in ninety per cent, of the cases a solu- 
tion of the difficulty can be found and by some modi- 
fication of the diet the baby may be kept on the 
breast. 

Menstruation. In case the mother begins to 
menstruate during the nursing period the milk 
usually is reduced in quantity and quality for a few 
days, so that some extra food may have to be given 



68 INFANCY AND CHILDHOOD 

the infant until the mother again has sufficient milk. 
This alone does not justify weaning the baby. 

Pregnancy. On the other hand, in case the 
mother becomes pregnant during the nursing period, 
the baby should be gradually weaned. First, be- 
cause the milk will rapidly deteriorate in quantity 
and quality, and, second, because the drain upon 
the mother is too great. 

Reasons for Infants Refusing to Nurse. 
When an infant refuses the breast but takes an 
artificial nipple, it is usually because it is easier to 
grasp, there is insufficient milk in the breast, or be- 
cause the food from the bottle is sweeter. 

If a baby takes the breast for a fraction of a 
minute and then lets it go and cries, and repeats this 
several times in succession, the usual reason is some 
obstruction, preventing nasal breathing, and conse- 
quent inability to nurse. The same symptoms will 
occur if a bottle is given in these cases. 

Weighing Before and After Nursings. Not 
infrequently when a baby refuses the breast it will 
be found that there is little milk there. The exact 
amount obtained at a feeding should be determined 
by accurate weighing before and after nursing. 

FISSURED NIPPLES 

Nipple Shield. When the nipples are sensi- 
tive it is frequently the result of fissures. Under 



BREAST FEEDING 



69 



these conditions a nipple shield should be used until 
they are healed and the nipples sponged frequently 
with a fifty per cent, solution of alcohol. In all 
cases after nursings the nipples should be sponged 
with an alcohol or boric acid solution in order to 
prevent infections of the breast. 

ADDITIONAL FOOD (MIXED FEEDING) 

At the age of seven to eight months a breast baby 
should begin to have some additional food. At 
first this may be a little soup 
or beef juice to which some 
toast or well cooked cereal 
has been added. When nine 
to twelve months of age the 
baby may have in addition to 
the soup two or three pieces 
of toast or zweibach daily. 
These pieces are about two 
inches wide and about three 
inches in length. Other food, such as rice, well- 
cooked oatmeal, or a little baked potato, may also 
be given. No food should be given between meals, 
but just before a feeding. 

It will be found that babies who are fed ex- 
clusively on breast milk during the entire first year 
are usually pale and the muscles flabby, while those 
given a little extra food will be plump and rosy. 




Nipple Shield 



70 INFANCY AND CHILDHOOD 

Infants fed exclusively on the breast during the 
first year are difficult to wean and frequently lose 
much in weight before they can be prevailed upon 
to take a proper amount of other food. 

WEANING 

At one year a baby should be fully weaned and 
if the milk is scant and it is receiving only a few 
ounces in the twenty-four hours, artificial feeding 
may be started to advantage earlier. 

Weaning is often more readily accomplished by a 
competent nurse than by the mother. 

The best plan is to wean the baby gradually. At 
seven or eight months an occasional bottle of prop- 
erly modified milk may be given, then two may be 
substituted for two of the nursings. After a time 
a bottle may be substituted for the breast at every 
other feeding. By this means no inconvenience may 
be felt by either mother or child and the increase in 
weight may continue without interruption. 

After one year the number of feedings should be 
cut dow r n to four in the twenty- four hours and a 
mixed diet given. (See Diet for Infants Twelve to 
Eighteen Months, page 115.) 

THE WET NURSE 

The best wet nurse is one who has a healthy, 
thriving baby of her own. She should continue to 



BREAST FEEDING 71 

nurse her own baby, and if she has not enough at 
first for both it is usually possible to supplement the 
breast milk with some other food. 

One must be sure that the wet nurse is not suf- 
fering from any communicable disease, such as tu- 
berculosis or syphilis. She and her baby should be 
carefully examined by a physician, and if there is 
any possibility of syphilis a blood test ( Wassermann 
reaction) should be "made. 

The diet and exercise of the wet nurse should be 
carefully regulated. Not infrequently an overin- 
dulgence in rich food is responsible for failures in 
wet nursing. A maximum of plain, nutritious food 
should be allowed at meal times, with plenty of 
water between. The habit of eating and drinking 
milk, etc., between meals usually results in a dis- 
ordered digestion, with an over rich milk supply. 
The nurse should have several hours' exercise in the 
open air daily and should have enough duties to per- 
form to keep her occupied and happy. 



VI 

ARTIFICIAL FEEDING 

The first thing to be remembered before putting a 
young infant upon an artificial food is that there is 
no real substitute for mother's milk. Even when 
a food is compounded of the same ingredients, in 
the same amounts as nearly as can be determined, 
still there is a wide difference in its effects and in 
the manner of its behavior in the digestive tract. 

Under certain circumstances infants must be fed 
artificially; therefore it is a matter of the most vital 
importance that a food be procured which will as 
far as possible meet the needs of the individual. 

In many instances serious conditions which affect 
the digestion and nutrition are produced at the very 
onset by giving a food which is not adapted to the 
infant's needs. 

Indigestion. Frequently an acute indigestion 
is produced from which it requires months to re- 
cover. 

The best available substitute for mother's milk is 
clean, fresh, properly diluted cow's milk. 

Any food which has not milk as a base is a dan- 
gerous food for any length of time. 

72 



ARTIFICIAL FEEDING 73 

Patent Foods. Some of the patent foods 
which claim to have milk as a base are also dan- 
gerous for continuous use when diluted as directed, 
owing to the large percentage of sugar and the 
small percentage of proteid and fat they contain. 

Difficulty in Getting Clean Cow's Milk. In 
preparing an artificial food the first step is to pro- 
cure fresh, clean, cow's milk from healthy cows. 
This may be difficult even in the country and in 
small towns where the cows are untested for tu- 
berculosis, the stables unsanitary and filthy, and the 
milk improperly cooled and cared for. In the large 
cities it is a hard, and many times an impossible, 
task to secure clean milk. When the source of the 
milk supply is distant the chances of contamination 
are legion. 

Since it is almost impossible for the average 
family in a city to procure ideal milk, it is important 
that great care be taken to get the best available. 

Tuberculin Tested Cows. Whenever possi- 
ble, people living in a city should own their own 
cows, which have been tested for tuberculosis. The 
stable and the cows should be kept clean. Before 
each milking the cows' udders should be washed 
with warm water, as well as the hands of the milker. 
There is no comparison between milk from a cow 
kept under such sanitary conditions and that pro- 
cured from the average milk-wagon. The wa- 



74 INFANCY AND CHILDHOOD 

ter-supply is a matter of the greatest import- 
ance. Wells are frequently infected by drain- 
age from the stables and outhouses, and the milk 
is frequently contaminated in this way. Other 
things being equal, the milk from a herd is 
more uniform and therefore better than that from 
a single cow. The great masses, however, are 
forced to procure milk from a dealer. 

Certified Milk. Certified milk x should be 
procured for infants whenever possible. The cost 
of this milk is somewhat more than the ordinary 
variety, but it is not usually prohibitive and the aver- 
age daily cost is much less than for any of the patent 
foods. When certified milk cannot be procured, the 
best milk possible, from a known source, should be 
purchased. The milk should be less than twelve 
hours old and should be kept on ice from the time 
of milking until it is used. 

Pasteurization and Sterilization of Milk. 
Since the sources of contamination of milk are many 
and the difficulty of determining the character of 
the milk so great, it is expedient that all milk {with 
perhaps the exception of certified milk) should be 
properly pasteurized, or boiled. We would not 
think of eating raw meat, and yet it is not nearly so 
fertile a source of contagion as milk. 

1 Milk certified by the Department of Health as having a 
bacterial count of not over 10,000 per c. cm. 





A Modern Sanitary Cow Stable Contrasted with the Old 
Style Disease-Breeding Conditions 



ARTIFICIAL FEEDING 75 

Contagious Diseases Carried by Milk. We 
now know that many :f the er:.:\" f ;:::s of infections 
disease, such as scarlet fever> diphtheria, tonsilitis, 
aftd typhoid fever, are frequently directly traceable 
to the milk supply. 

The pasteurization of milk changes its character 
very little. a::d boiling for a short time (two min- 
utes; does not change it sufficiently to outweigh its 
ntages on the side of safety. 1 

Richness of Milk. For infants the milk rich- 
est in far should not be sought, but rather milk only 
moderately rich. Milk from a herd is usually to be 
preferred to milk from one cow. 

Breed of Cows. Holstein as a breed produce 
milk particularly adapted to infants. The fat per- 
centage is rather low and the fat globules small. 

THE CARE OF MILK IN THE HOME 
After having secured the best milk possible it is 

necessary that it be kept pure and cold. 

All milk for infants should be poured at once 

a::er milking into clean bottles which have been 

sterilized by live s:ea::: or boiled, and placed upon ice 

until delivered. 

Temperature for Pasteurization. As soon as 

the milk is received at the home it should be pre- 

1 The City of New York now requires that all milk sold 
within the corporation, with the exception of A grade, be either 
pasteurized or boiled. 



76 INFANCY AXD CHILDHOOD 

pared according to the formula prescribed. It 
should then be poured into nursing bottles, one for 
each feeding during the twenty- four hours, and each 
stopped with a plug of sterilized cotton wool. 
These bottles should first be thoroughly cleaned 
and boiled. The whole feeding may then be pas- 
teurized by placing the bottles in a water bath until 
the temperature of the milk reaches 170° F. and 
then allowed to stand at this temperature for twenty 
minutes, or the milk may be first brought to the 
boiling point for a couple of minutes and then poured 
into the bottles. The bottles should then be placed 
on the ice until needed. Just before using a bottle 
it should be placed in warm water until the milk 
reaches the proper temperature (blood heat). 

Milk left in a bottle after a feeding should never 
be used for a second feeding, but should be dis- 
carded and the bottle filled with water until it is 
cleaned and boiled. 

Improper Pasteurization. The safest and 
simplest method for the average family to pursue 
is to boil the milk. Pasteurization under any cir- 
cumstances does not kill all germs, and if improp- 
erly done it is worse than no pasteurization at all. 
Heating milk to an insufficient temperature merely 
stimulates the growth of organisms. 

Where ice cannot be procured, milk which has 
been boiled and rapidly cooled, if kept in a cool 



ARTIFICIAL FEEDING 77 

place, sealed from the dust and flies, will be com- 
paratively safe for twenty- four hours. 

Ice Box. A simple ice box can be constructed 
at a cost of fifty cents which will keep a baby's milk 
cold at an expense of two or three cents per day. 
(See directions on pages 97-98.) 

It must be remembered that pasteurization, or 
boiling, will not transform filthy milk into clean 
milk. It will, however, remove the chances of such 
epidemics as some of our cities have suffered from 
during the past years. 

Nipples. Nipples should be thoroughly 
cleansed and kept free from moisture in a covered 
glass jar until needed. 

The habit which many mothers have of putting 
the nipple into their own mouths before giving it to 
the baby should be absolutely prohibited, as this is a 
frequent source of infection. 

Thermos Bottles. Thermos bottles may be 
used to keep milk cold, but never to keep milk 
warm, since germs develop rapidly in warm milk. 

The milk may be heated rather rapidly by putting 
the bottle under the hot-water faucet. Great care 
must be taken in the use of alcohol lamps, as fre- 
quent accidents happen in this way, and especially 
at night. 



78 IXFAXCY AND CHILDHOOD 

Composition of Cow's Milk as Compared with 

Mother's Milk 

Mother's Milk: Con's Milk: 

Per cent. Per cent. 

Fat 4 Fat 3-4 

Sugar 7 Sugar 4j4 

Proteid iVi-iYa Proteid 3-3^ 

Mineral Salts . . % of 1 Mineral Salts ... % of 1 

Water, about ... 88 Water, about . . 88 

It will be noticed by a comparison of the two kinds 
of milk that the chief apparent difference is in the 
amounts of sugar, proteid and salts. 

Mothers milk contains about 3 per cent, more 
sugar than cow's milk, and cow's milk contains 
about twice as much proteid as mother's milk. 
Cow's milk also contains two to three times as much 
mineral salts as mother's milk. 

A study of these percentages has suggested to 
many in the past the possibility of substituting for 
mother's milk a chemically identical modification of 
cow's milk. This theory, however, was found to 
be false, as no amount of modification of the milk 
of one species can transform it into that of another. 

Percentage Feeding. It was, however, found 
necessary to modify cow's milk for young infants 
and the method generally known as Percentage 
Feeding was adopted. This is the system generally 
described in the books on children. 



ARTIFICIAL FEEDING 79 

Food Elements. This method is somewhat 
difficult for the average mother and approximately 
the same results can be obtained by simple dilutions 
of milk. This method will be described here. 

Caloric Values. The different elements of 
the food : fat, sugar, and proteid, have definite food 
values. The food value is measured in units called 
calories, a calorie being the amount of heat required 
to raise one litre (approximately a quart) of water 
one degree centigrade. 

The food or caloric value of proteid and sugar 
are the same, 120 per ounce, while that of fat is more 
than twice as much as either of the other elements. 
(For caloric values of different foods, see chart on 
page 185.) 

WHOLE MILK AND CREAM 

By whole milk is meant the milk as it comes 
from the cow, without any modification. By 
cream is meant the part of the milk which rises to 
the top of the bottle after standing. It is usually 
known as gravity cream and has a fat content of 
about 16% in contrast to centrifuge cream, which 
has a fat content of about 32%. 

MODIFICATION OF COWS MILK FOR INFANTS 

Cow's milk is usually modified by diluting it with 
some fluid, such as water or gruel, and then adding 



8o 



INFANCY AND CHILDHOOD 



sufficient of whatever elements are necessary to 
bring them up to the proper percentages. (For 
Sugar and Gruel, see pages 89-90. ) 

Since the caloric value of cow's milk is practically 
the same ounce for ounce as mother's milk, it is ap- 
parent that if we dilute cow's milk we must either 





Chapin Cream Dipper 



Cream Dipper in Use 



give a greater quantity or add something to bring 
up its food value. 

The usual procedure, therefore, is to dilute cow's 
milk and then add such a percentage of sugar and 
cream as the individual case will tolerate. 

Since individual infants differ so widely in their 
tolerance of fat and sugar, it is always advisable to 
begin with low percentages of these elements and 
gradually increase to the proper amount. 



ARTIFICIAL FEEDING 81 

Tolerance of Fat. Young babies will not 
usually digest as much cream in cow's milk as is 
normally found in mother's milk. For the average 
normal infant the following rules for feeding may 
be observed. It will be found, however, that there 
are many exceptions in which the milk will need 
further modification. These changes will be found 
to be more often necessary with the fat than with 
the proteid. If the milk is not first boiled, or some 
alkali, such as lime-water or potassium citrate, 
added, large cheesy curds of cow's milk frequently 
give trouble in passing the small end of the stomach. 
(Pylorus.) 

It is always well in beginning with cow's milk to 
give much less in quantity than the infant needs 
and increase as rapidly as the tolerance will permit. 
By adhering to this rule many serious digestive dis- 
turbances will be avoided and in the long run 
greater progress will result than if the infant is put 
upon a full amount of food from the start. 

The rapid gain in weight for which so many 
young mothers strive is often obtained at a great 
sacrifice. 

Great increase in weight is of much less impor- 
tance than normal digestion, which if maintained 
will mean a steady gain in weight and nutrition and 
a happy, contented infant. 



82 INFANCY AND CHILDHOOD 

QUANTITY OF FOOD AT A MEAL 

It is a safe rule to give at a feeding a quantity 
in ounces corresponding to the age of the baby in 
months, plus one. For example, at three months, 
four ounces; five months, six ounces, etc., up to 
eight months, when the quantity at a feeding should 
not be increased. 

When only five feedings are given in twenty-four 
hours, and when the milk is well diluted, this quan- 
tity will have to be exceeded in order that the infant 
shall get the proper amount of food. If, however, 
too large a quantity is given, the stomach walls will 
become permanently stretched and thereby lose the 
power of contraction. 

MILK FORMULA 

In normal infants the following formula will 
usually be tolerated : For the first few days — One- 
fourth whole milk, i.e., whole milk five ounces, 
three- fourths, boiled water — boiled water fifteen 
ounces. 

Give two ounces every three or four hours for six 
feedings. 

After a few days if the stools are good and there 
is no vomiting, some sugar (cane, milk or malt) 
may be added. This should be done gradually, add- 
ing at first one teaspoon and increasing up to one 



ARTIFICIAL FEEDING 



83 



ounce or eight level teaspoons in a twenty-ounce 
mixture. 



<SfiSJeSj jfi/£ 




/£% /roi^AQ \/a./ue 60 Ca/o 




47S/S S^ar- VL/<se /SO C<a./or'C?J 



Jv S c*.r I 

fr &,dW~ 






79% Jvg<*r Vet/is* Joo Co./or/es 



/£ % /ZcTJr/ct. l£/ u<? &o C*./o' 






79% Sugar \/o\Ase ~3oo az/or/es 



£^-% /£o-£/<^ Va/'j& %o C<*^-/ej. 



The charts show the relative percentages and caloric values 
of one quart of mother's milk and cow's milk and of one 
quart mixtures of condensed milk and malted milk contain- 
ing essentially the same amount of solid matter. 

If the stools become thin or green the sugar 
should be reduced or excluded. 

By the end of the first week the milk may usually 



84 



INFANCY AND CHILDHOOD 



be increased up to one-third, with two-thirds boiled 
water, thus: 

Whole milk, seven ounces. 
Boiled water, fourteen ounces. 
Sugar, one-half of one ounce. 1 

Give two and one-half or three 
ounces every three hours for six 
feedings; for example, at six, 
nine, and twelve a.m., and three, 
six, and twelve p.m. 

The milk and sugar should be 
increased on alternate days, the 
milk increased one-half to one 
ounce at a time, and the sugar 
one-half to one teaspoon at a 
time. 

After two or three weeks the 
milk may gradually be increased 
up to one-half milk and one-half water, plus one 
ounce sugar; that is, about three rounded table- 
spoons. 
Whole milk, twelve ounces. 
Boiled water, twelve ounces. 
Sugar, one ounce. 

1 By weight By measure 

I ounce Cane Sugar i-Y 2 ounces 

I ounce Malt Sugar (Dextro Maltose) I-J4 ounces 

I ounce Brown Flour 2-J4 ounces 

I ounce Barley Flour 2- 1 /^ ounces 

I ounce Oatmeal 3-J4 ounces 




Pint Graduate 



ARTIFICIAL FEEDING 85 

Give three or four ounces every three or four 
hours for six feedings. 

This formula may be given up to six or eight 
weeks, after which the amount of milk may be 
gradually increased. 

If the digestion is normal and the baby does not 
gain from four to six ounces weekly, the food may 
be increased in strength so that at three months it 
is taking five ounces at a feeding of a one-half milk 
and one-half water or cereal mixture with sugar, 
thus: 

Whole milk, fifteen ounces. 

Water, barley, or oatmeal gruel, fifteen ounces. 

Sugar, one — two ounces. 

Give five ounces every three or four hours for six 
feedings. 

Between three and six months the milk may grad- 
ually be increased to two-thirds, with one-third 
water or gruel and one to two ounces of sugar. 

(If there is a tendency to vomiting the period 
between feedings should always be four hours.) 

Whole milk 17-24 ounces 

Water or gruel 18-1 1 ounces 

Sugar 1-2 ounces 

Give six or seven ounces at three or four hour 
intervals for six or five feedings. 

From six to nine months the proportion may re- 



86 INFANCY AND CHILDHOOD 

main at two-thirds milk and the quantity increased 
up to eight ounces, thus : 

Whole milk 24-32 ounces 

Gruel 16- 8 ounces 

Sugar 1 ounce 

Eight ounces for five feedings. 

At the seventh or eighth month some extra food, 
such as a piece of zweibach (toast) soaked up with 
beef juice, or soup, may be given at the feedings two 
or three times daily. No food should be given be- 
tween feedings, except perhaps a little orange, prune 
or other fruit juice, well diluted with water. 

No infant should ever have more than a* quart 
{thirty-two ounces) of milk during the twenty-four 
hours, and when more food is needed, other things 
than milk should be given. 

From nine months on, the proportion of milk may 
be gradually increased so that at one year whole 
milk may be given. 

After nine months it is often well to give only 
four milk feedings and one in which there is little 
or no milk but an equal quantity of good soup in 
which has been cooked some, rice and a little veg- 
etable, all put through a fine sieve. The soup should 
have the consistency of gruel. 

It will be found that infants who receive some 
food in addition to the milk after the seventh or 



ARTIFICIAL FEEDING 



B7 



eighth, month will be much better nourished at the 
end of the first year than those fed exclusively on 
milk. 



FEEDING SCHEDULE FOR FIRST YEAR 









1 :.cnty-four i 


hour quantity 








*■, 














~ S 
*= ^ 




«o 


»a 


*i 




•< 


Age 














li 


ist week 


1-2 


7-6 


6-7 


14 




1-4 


21 


2- 3 rd • 


2-3 


:-: 


8-io 


13-11 




3-6 


21 


3-^th ■ 


3-4 


6 


IO-I2 


14-12 




6-8 


24 


6-8th " 


4-5 


6-5 


12-15 


18-15 




6-12 


30 


2-3 rd mo. 


5-6 


6-5 


5 -:S 




-5" - 


6-12 


30 


3-5th " 


6-7 


5-5 


18-24 




18-12 


6-12 


:: 


5 --:n " 


7-S 


S 


24-30 




16-IO 


6-12 


40 


r-v:h - 


8 


5 


}'--}- 




IO-8 


4 


_:■ 


:-:-:h * 


8 




w 


B 





40 



It must not be assumed that the above formulae 
will be satisfactory in every case. Radical modifica- 
tions may be necessary. In vigorous infants, the 
amount of milk during the first few months may 
have to exceed that given in the foregoing formulae. 

Pale, Dry Stools. When the stools are very 
pale and dry. or where they contain small, white 
curds, some of the cream should be removed from 
the milk and more starch or sugar addc 1 

Large Curds. Sometimes when unboiled milk 



88 INFANCY AND CHILDHOOD 

is used, large, hard curds, the size of a pea or a 
bean, appear in the stools. Under these circum- 
stances the milk should be diluted and boiled for a 
minute or two. 

Hard, pale stools are usually the result of too 
much fat in the food. Under these conditions the 
urine often has a strong ammoniacal odor. In 
these cases practically all of the cream should be 
removed from the milk and in. its place sugar (bet- 
ter malt sugar) and some starch, such as barley, oat- 
meal or white flour, added. 

Buttermilk with the addition of sorne sugar and 
starch is often a&n ideal diet in these cases. (See 
pages 93-940 

After a period of from two to three months on 
a low fat diet a certain degree of tolerance to fat 
is again established. Cream must be added, how- 
ever, very slowly, and never in any large amount. 
When cream cannot be tolerated some cod-liver 
oil or olive oil may frequently be given to advan- 
tage. 

Loose Acid Stools. In cases where the stools 
are too loose and the skin around the rectum is 
irritated by the discharges, the sugar is usually in 
excess and should be cut down or removed entirely. 
If the movements are still loose, the gruel should 
also be removed and boiled water substituted as a 



ARTIFICIAL FEEDING 89 

diluent. Sometimes a brown flour gruel will be 
tolerated when ordinary starch or sugar will not. 
The sugar and starch may usually be added later in 
small quantities. 

HOW TO TELL WHEN THE FOOD IS AGREEING 

If the baby is happy, not vomiting, and its stools 
are normal in character, and if in addition its color 
is good and it is gaining moderately in weight, there 
is probably nothing seriously wrong with the food. 

It is a good rule not to change the food as long as 
the baby is well and gaining a sufficient amount 
weekly in weight, that is, four to six ounces. 

SUGAR 

Cane sugar may usually be used instead of malt 
or milk sugar. Its food value is about the same and 
it has among other things the advantage of being 
much cheaper. 

Malt sugar, obtained usually in combination with 
dextrin, has the advantage over the other forms of 
being more laxative. It is, however, expensive, 
as is milk sugar, costing from thirty to fifty cents 
per pound. It is this form of sugar which consti- 
tutes a large element of many of the patent foods, 
and it is to the malt sugar that the laxative prop- 
erty of these foods is due. 



90 INFANCY AND CHILDHOOD 

USE OF GRUELS IN THE DILUTION OF MILK 

Gruels are made usually from some of the grains, 
such as wheat, barley, oats, rice, etc. These flours 
consist largely of starch. 

During the first few weeks of life it is better not 
to use gruels to any great extent, and if they are 
used at all they should be very thin and thoroughly 
cooked (several hours). 

It is usually not well to exceed one-half to one 
ounce (two to three tablespoons) of wheat, barley, 
oatmeal, arrowroot, or rice flour, to the quart of 
water. As the water boils away more should be 
added, keeping the quantity up to a quart. (Page 
186.) 

The food value of starch is the same as that of 
sugar; in fact, in the process of digestion starch is 
changed to sugar and is assimilated as such. 

The food value of the different starch gruels, 
ounce for ounce, is practically the same. There is, 
however, some slight difference in the way they 
act in the digestive tract. 

Oatmeal has a slightly higher food value and is 
perhaps more laxative than the others. 

Rice, on the other hand, is the most constipating. 

Where laxative properties are sought it will be 
found that a gruel made from whole-wheat flour 
(containing the bran) will be particularly efficacious, 



ARTIFICIAL FEEDING 91 

It will be necessary to strain the gruel through a 
fine sieve in order to remove the large particles of 
bran. 

SUBSTITUTES FOR FRESH MILK 

There are times and places when fresh cow's milk 
is not available. If the baby has been weaned and 
a wet nurse cannot be procured, probably the best 
substitute for fresh milk is condensed milk. 

In giving condensed milk it must be remembered 
that it has been sterilized and contains a large per- 
centage of cane sugar, so that it is not well to keep 
an infant upon it for any length of time without 
adding some other element, such as beef juice and 
orange juice. 

Some of the other patent foods contain milk in a 
dried form, together with a large amount of malt 
sugar. Some of these may be given for short 
times, but never for months at a time without the 
addition of other elements, as in the case of con- 
densed milk. 

Infants fed exclusively on condensed milk, or on 
almost any of the proprietary foods, are liable to 
be pale, and many of them suffer from rickets. 

No food which does not have milk as a base 
should be used for infants. 

Proprietary Foods. The chief arguments 
against the use of proprietary foods in general are: 



92 INFANCY AND CHILDHOOD 

They are inferior in nutritive value to properly 
modified fresh milk. 

They are expensive, costing two or three times as 
much as cow's milk. 

They usually contain a large percentage of sugar 
and too low a percentage of proteid and fat : essen- 
tial elements in any food. 

The continued use of these foods is liable to pro- 
duce rickets or some other form of malnutrition. 

Scurvy. Infants fed upon any proprietary or 
sterilized food should have daily some uncooked 
fruit juice, such as orange or pineapple. When 
this is not given the infant may develop scurvy. 
A few teaspoons of fruit juice daily, well diluted 
with water and given between meals, is all that is 
necessary to prevent scurvy. 

SPECIAL PREPARATIONS OF MILK 

Peptonized Milk. Peptonized milk is made 
by adding a certain amount of pancreatic ferment 
to milk and bringing the mixture to the body tem- 
perature for a given time. Milk w T hich has been 
over peptonized is bitter to the taste. Written direc- 
tions for the use of the different peptonizing prep- 
arations always accompany the package. There is 
a limited use for peptonized milk in certain forms 
of digestive disturbances. It should not be used 
continuously and only under a physician's directions. 



ARTIFICIAL FEEDING 93 

Buttermilk. Buttermilk is sour milk from 
which the fat has been removed. It is usually ob- 
tained as a by-product in the process of making 
butter. It may be made, however, by souring 
skimmed milk. The souring process may be aided 
by the addition of lactic acid bacteria, which are 
put up by several firms in the form of tablets. 

Buttermilk and sour milk have been used as an 
article of diet from time immemorial. Its use is 
mentioned more than once in the Old Testament. 
It is, however, comparatively recently that it has 
been used in this country as a food for infants. 
In Holland, however, buttermilk has been used as a 
remedy for the summer diarrhoeas of infants for 
several hundred years. 

In certain conditions, especially where fat is not 
well tolerated, buttermilk may be given to advan- 
tage. In diarrhoea, especially that form produced 
by overfeeding with fat, the use of buttermilk is 
often followed by brilliant results. 

The so-called lactone milk may be made from 
whole milk and thus contains a large amount of fat. 
Since buttermilk is usually prescribed for babies 
who stand fat badly, care should be taken to specify 
skimmed milk. 

Buttermilk should always be made from clean 
milk and should be made fresh daily. It may be 
used raw and diluted if necessary, or it may be 



94 INFANCY AND CHILDHOOD 

boiled, and, in order to increase the food value, flour 
and sugar may be added. 

The following is the author's modification of 
Baginsky's buttermilk formula : 1 

Fresh Buttermilk i quart 

Browned wheat flour i to 3 tablespoons 

Sugar (cane) 1 to 3 tablespoons 

Mix together until smooth and put on slow fire 
and with constant stirring allow to boil for three 
or five minutes. Divide into a proper number of 
feedings for twenty-four hours and place on ice 
until needed. Before feeding the mixture should 
be thoroughly shaken and warmed to the proper tem- 
perature. 

Malt soup may be used under much the same con- 
ditions as the buttermilk formula. 

Malt Soup. 

Full milk, one-third quart. 

Water, two-thirds of a quart. 

White flour, one to two ounces. 

Malt soup extract one to two ounces. 

Mix flour and water and bring to a boil. 

Then add malt extract and bring to a boil. 

Lastly, add the milk, stirring constantly and bring 
to a boil the third time. 

Cool off quickly by standing it in iced water. 

1 Buttermilk as an Infant Food, Ramsey, Walter R., St. 
Paul Medical Journal, Jan. 1, 1904. 



ARTIFICIAL FEEDING 95 

This food has practically the same caloric value 
as whole milk. 

If the food is too laxative, less of the malt ex- 
tract should be used. 

Casein Milk. Casein Milk is made by curdling 
whole milk with rennet and then straining out the 
whey through cheesecloth. The whey is thrown 
away and the curds mixed with water, forming a 
smooth mixture like the original milk. By this 
method all the sugar and most of the salt have been 
removed. A certain amount of fresh buttermilk is 
then added and the mixture is ready for use. This 
preparation should be made and used only under 
the direction of a physician. 

Whey. Whey is made by curdling sweet milk 
with rennet and then straining off the liquid portion 
through a fine sieve or cheesecloth. 

Whey contains a certain amount of albumen and 
also all the sugar and salts contained in the milk. 

Whey may be used to advantage in certain gas- 
trointestinal affections. It will frequently be re- 
tained when milk containing the fat and curd would 
be rejected. 

BOTTLES AND NIPPLES 

The simple graduated bottles are inexpensive and 
if care is taken they can be kept clean as well as any 
of the more expensive varieties. 



96 



INFANCY AND CHILDHOOD 



The nipple should be of the simple variety which 
can be purchased at any drug store. 

Nipples should be selected with small openings, 
as there is a tendency for infants to get their food 








The Arxc 



IRILIZER AND 



too fast. If the opening is too small it can readily 
be made larger by heating a small sewing needle to 
a red heat and burning the opening to the size de- 
sired. Blind nipples may be purchased and the 
openings made the size desired. 



ARTIFICIAL FEEDING 



97 



STERILIZERS AND PASTEURIZERS 

There are a number of these on the market, any 
of which will be perfectly satisfactory. 

A simple arrangement, which is, however, equally 
efficient, consists of a rack made to hold the proper 
number of bottles in an upright position (any tin- 




A Simple Home-Made Ice Box 



smith will make one). This rack should have a 
handle so that it can be set in a pan of water. This 
with a dairy thermometer is all that is required in 
the way of apparatus in the pasteurization, or sterili- 
zation, of milk. (See opposite page.) 



9 8 INFANCY AND CHILDHOOD 

ICE BOX 

Where a large ice box of the standard varieties is 
not available a small one, large enough to keep the 
baby's milk cold, may be made at the expense of a 
few cents. An ordinary box is procured at the 
grocery store, say two feet square. In this box is 
placed another box three or four inches smaller in 
all dimensions except in height, which should be the 
same. Between the two is packed sawdust. A 
lid, which has many layers of newspapers tacked on 
the inside, completes the ice box. A small amount 
of ice, one to two pounds, will keep the feedings 
cold for twenty- four hours. 



VII 



TEETHING (DENTITION) 

The first teeth appear usually from the sixth to 
the ninth month. There are exceptions when they 
appear much earlier. There are twenty teeth in 
the first set, known as temporary, or deciduous, 
teeth. They appear usually in the following order : 

Two lower central incisors, fifth to ninth month. 




Temporary or Milk Teeth 

i Central incisor. 

2 Lateral incisor. 

3 Stomach or Eye tooth. 

4 First molar. 

5 Second molar. 

Four upper, two central, and two lateral incisors, 
eighth to twelfth month. 

Two lower lateral incisors and four double teeth, 
twelfth to eighteenth month. 

99 



ioo INFANCY AND CHILDHOOD 

Four canine teeth (the upper two known as the 
" eye teeth " and the lower two as the " stomach 
teeth "), eighteenth to twenty-fourth month. 

Four back double teeth, twenty-fourth to thirtieth 
month. 

At one year a child usually has six teeth. 

At one and one-half years, twelve teeth. 

At two years, sixteen teeth. 

At two and a half years, twenty teeth. 

The most common causes of delayed and irregular 
dentition are prolonged illness and rickets. 

THE PERMANENT TEETH 
The permanent teeth are thirty-two in number 
and appear approximately at the following ages : 

First molars 6 years 

Incisors 7 to 8 years 

Bicuspids 9 to 10 years 

Canines 12 to 14 years 

Second molars 12 to 15 years 

Third molars (wisdom teeth) 18 to 21 years 

When the permanent teeth come in irregularly 
their position should be corrected during childhood, 
while the bones are still soft. Skilled dentists can 
now correct the most extreme irregularities. 

SYMPTOMS DUE TO TEETHING 

Contrary to what has generally been believed by 
the laity, there are very few symptoms of any grav- 



TEETHING (DENTITION) 



IOI 



ity which can be attributed directly to the " cut- 
ting " of the teeth. 

It must be remembered that the process of teeth- 
ing is more or less continuous, extending over the 
first two and one-half years of life. It is, however, 
just before the time when the teeth appear on the 
free surface of the mucous membrane that the most 
pronounced symptoms are supposed to show them- 
selves. 

The fact is that the great majority of children get 
their teeth without any symptoms at all. There are, 
however, a certain percentage of children, particu- 

t 




Permanent Teeth 

i Central incisor. 

2 Lateral incisor. 

3 Canine or Eye tooth. 

4 First bicuspid. 

5 Second bicuspid. 

6 First molar. 

7 Second molar. 

8 Third molar or Wisdom tooth. 



larly those of a nervous temperament, who, just 
before the appearance of a tooth, may be fussy, 
sleep badly, drool constantly, not take all their 



io2 INFANCY AND CHILDHOOD 

food, and perhaps have some slight diarrhoea. 
There may be a slight elevation of temperature. 
Upon examination of the mouth there may be 
found some redness in the region of the prospective 
tooth. 

In the presence of such symptoms the food should 
be reduced in quantity and quality, and if the symp- 
toms persist a physician should always be consulted. 

Severe symptoms of any kind should never be at- 
tributed to the teeth, as they are practically always 
due to some other cause. 

The habit of " rubbing the tooth through " 
should be discouraged, as more harm than good is 
sure to result. It is rare that lancing of the gums 
is necessary and is usually contraindicated. In the 
case of a nervous infant a warm bath at bedtime 
will frequently relieve the nervous tension and will 
often be followed by several hours of sound sleep. 

CARE OF THE TEETH 

The teeth are a very important factor in the 
process of digestion. It is therefore important that 
they should be carefully preserved. The accumula- 
tion of food on and around the teeth frequently re- 
sults in destruction of the enamel and the forma- 
tion of cavities from decay. Decayed teeth are in- 
jurious to health in several ways: 



TEETHING (DENTITION) 103 

Filthy and decayed teeth harbor a great va- 
riety of germs, which are swallowed with the 
food. 

With badly decayed teeth it is impossible to prop- 
erly masticate the food. 

Decayed teeth frequently result in the formation 
of abscesses at the roots and around the teeth. This 
may be followed by destruction of the bone which 
holds the teeth in place and in marked enlargement 
or even breaking down of the adjacent glands. 
There may be serious poisoning of the general sys- 
tem from absorption. Infected teeth are undoubt- 
edly a common cause of tonsilitis. The author has 
recently seen a severe affection of the tonsils pro- 
duced in this way. 

The temporary teeth are necessary to the proper 
development of the jaws and consequently to the 
position and character of the permanent teeth. 

Not infrequently owing to malnutrition the in- 
fant's teeth are defective when they appear. 

The giving of sweets to children, together with 
lack of cleanliness, is a potent factor in causing 
decay. 

Every child should have its teeth brushed at least 
once daily, and at the age of three years should be 
taught to perform this task itself. The spaces be- 
tween the teeth should be kept clean from accumu- 
lated food by the use of dental floss. 



104 INFANCY AND CHILDHOOD 

TONGUE TIE 

It is rare that the frenum of the tongue requires 
cutting. If the tongue can be projected beyond the 
lips, no operation is necessary. Such an operation 
may frequently result in infection or in severe 
hemorrhage. 



VIII 

THE STOOLS AND URINE 

The first few stools of a new-born baby are com- 
posed of a black tar-like substance called meconium. 
After a few days, when the baby has had some breast 
milk, the color begins to be lighter and within a 
week becomes yellow. Not infrequently just before 
they become yellow there is a greenish tinge which 
is often mistaken for " green stools." 

The normal color of the stools of a breast-fed 
infant is about that of the yolk of egg. The con- 
sistency is that of thick gruel; later it is mushy in 
consistency and sometimes partially formed. The 
number may vary normally from one to three in 
twenty- four hours. 

The stools of a breast baby may vary much, with- 
out the variation being of any special significance. 

If a baby is well nourished and gaining normally 
in weight one need not be too critical about the 
stools. An occasional greenish stool under the 
above conditions has no special significance. If, 
however, the stools are persistently green the baby is 
either overfed or underfed. 

105 



106 INFANCY AND CHILDHOOD 

If the stools are persistently full of white curds, 
it is usually overfed. 

Greenish, curdy stools practically always mean 
overfeeding, especially with fat. 

On artificial food the stools differ much in appear- 
ance, depending upon the character of the food. 

The normal stool of an infant fed upon cow's 
milk diluted with water is canary yellow and of a 
firmer consistency than those fed on breast milk. 
When gruels and the different sugars are added to 
milk the color is changed. Malt sugar, malted milk, 
and other malted foods usually give the stools a 
brownish color. 

Persistently green stools in bottle fed infants al- 
ways mean some form of indigestion and the food 
should be modified. 

CONSTIPATION 

Much of the constipation from which infants 
suffer is produced by interference by the nurse or 
other attendants during the first few weeks of life. 
The bowels will not move normally unless the lower 
part of the rectum is full of fecal matter. During 
the first week of life an infant usually gets little 
food. After the meconium is passed there are fre- 
quently several days required before there is much 
residue left over from the food. If during this time 
the infant is given castor oil, suppositories, or in- 



THE STOOLS 107 

jections, the normal process is interfered with at 
the outset and the proper stimulus in the rectum is 
lacking. The result is that by the time the nurse 
goes the infant has the " constipation habit." If 
breast (or, for that matter, bottle) babies were al- 
lowed to go a day or two until their bowels move of 
themselves, there would be less constipation. 

Where constipation is present in breast infants 
cathartics as a routine should not be given. Fre- 
quently a teaspoon of prune juice before or after a 
nursing will correct the difficulty. 

In artificially fed infants where the stools are 
hard and dry the food should be modified. Habit 
is an important factor in overcoming constipation. 
Infants as young as six months may be taught to 
have a regular time for bowel movements. 

Graham Flour for Constipation. Abdominal 
massage if properly given is often effective. 
Glycerine suppositories should never be used con- 
tinuously; they produce a w T atery stool, but always 
at the expense of the normal secretions. In older 
infants and children graham flour gruel or graham 
bread is a sovereign remedy for constipation, the 
.bran being the laxative element. Coarse foods, 
fruits and vegetables, plenty of exercise, with regu- 
larity in going to stool, are the essential elements in 
the treatment of constipation. Infants who have 
suffered much from constipation are frequently much 



io8 INFANCY AND CHILDHOOD 

improved when the cow's milk can be diminished and 
the other articles of food increased. 

Fissures in the Anus. Infants who suffer 
much from constipation and who have been sub- 
jected to much local irritation frequently have 
fissures in the anus; they are painful and frequently 





Soft Rubber Syringes 

result in the infant crying severely when the bowels 
move. 

When constipation is persistent and where there is 
some digestive disturbance, irrigation of the bowel 
with normal salt solution (one teaspoon salt to pint 
of boiled water) introduced by means of a bulb 
syringe, with a soft catheter attached, may be re- 
sorted to. 

The continuous use of laxatives, suppositories, or 



THE STOOLS 109 

irrigations will never result in the cure of con- 
stipation, but will tend to aggravate the condi- 
tion. 

THE URINE 

The urine in infants is of a light amber color. It 
does not stain the napkin, or only slightly. If 
jaundice is present the urine contains bile pigment 
and stains the diaper yellow. Occasionally mothers 
are much concerned about a red brick dust deposit 
on the diaper. This has no serious significance and 
results from the elimination of uric acid. Urine 
which stains the diaper and has a strong odor of 
ammonia usually indicates some digestive disturb- 
ance. This condition frequently occurs in arti- 
ficially fed infants who are having more fat than 
they can tolerate. Blood in the urine may be of 
serious moment and should always be reported to the 
physician. Frequent urination, with straining and 
crying, indicates the presence of inflammation in the 
bladder. Urine for the physician's use should al- 
ways be fresh and contained in a clean vessel. The 
securing of a specimen of urine from an infant is not 
so difficult as is generally supposed. If the diaper 
is removed and the baby is carefully watched, a re- 
ceptacle being at hand, a specimen can usually be 
procured in a few hours. Xot infrequently the 
placing of a cool sponge over the bladder will result 



no INFANCY AND CHILDHOOD 

in the child's voiding urine. If these means are 
not successful the physician can always furnish a 
simple appliance for collecting urine both from male 
and female children. 



IX 

OVERFEEDING 

Certainly the most common cause of digestive 
and nutritional disturbances in infants is overfeed- 
ing. 

Many of the serious digestive troubles from which 
infants suffer during the hot weather (vomiting and 
severe diarrhoea) are due to overfeeding. 

An infant should be fed the least amount upon 
which it will gain sufficiently in weight and nutrition. 

When the stools are large and of a foul odor the 
infant is usually overfed. 

One of the most common causes of skin eruptions 
(eczema) is overfeeding. 

Overfeeding with sugar and starch is usually 
manifested by sour stools which burn the skin 
around the rectum. 

Overfeeding with fat is manifested often by vom- 
iting, or by typical changes in the stools. 

Loss of Weight Due to Overfeeding. Infants 
who are much overfed usually stop gaining after a 
time and then lose weight. The proper gain in 

in 



ii2 INFANCY AND CHILDHOOD 

weight may frequently be reestablished by reducing 
the quantity of food to the right amount. 

VOMITING OR REGURGITATION 

The most common cause of regurgitation is pos- 
ture. Any infant will regurgitate a portion of its 
meal if doubled up or carried about, pressure being 
upon the stomach. 

Other causes are : 

Overfilling of the stomach. 

Too rich food. 

Obstruction to the passage of food from the stom- 
ach (pylorospasm or stenosis). 

Posture During and Following the Meal. In- 
fants should receive their food slowly and always 
while lying in a comfortable position on the back or 
right side, the upper portion of the body slightly 
elevated. 

The bottle should be held by the attendant and 
the time occupied should not be less than fifteen to 
twenty minutes. After the food has been taken the 
infant should remain in the recumbent position. If 
the baby is uncomfortable, raising it into the sitting 
posture will often suffice to relieve the stomach of 
air which it has swallowed with the milk, when it 
should be put down again. An infant should never 
be carried about after a meal and should be disturbed 
as little as possible for at least two hours. 



OVERFEEDING 113 

Vomiting. When an infant vomits just before 
the time for the next meal, the food should be re- 
duced and the time between feedings increased. 

When an infant vomits persistently after all sim- 
ple remedies have been tried, a physician should al- 
ways be consulted. 

When an attack of vomiting occurs in an infant 
which has heretofore not been in the habit of vomit- 
ing, all milk should at once be stopped, and for a 
few feedings boiled water, barley water, or some 
other thin gruel given. 

If vomiting persists, all food should be stopped 
and a physician consulted. 

Recurrent Vomiting. Recurrent attacks of 
vomiting are not uncommon in older children, par- 
ticularly those of a nervous temperament. They 
occur at irregular intervals and frequently without 
any apparent cause. 

The attack may last for several days, during 
which time not even water can be retained. 

The diet in these children should be carefully 
supervised and only the plainest food permitted. 

After an attack the child, if allowed, will gorge 
itself with food, with the result that one attack will 
follow another at short intervals. 

Since vomiting accompanies so many other con- 
ditions, a physician should always be consulted. 



H4 INFANCY AND CHILDHOOD 

COLIC 

Colic is only another name for indigestion. It is 
practically always produced by overfeeding or im- 
proper feeding. 

The mistake is often made in thinking that in- 
fants are hungry because they cry and take food 
eagerly, when in reality they are suffering from in- 
digestion due to overfeeding. The taking of food 
of course only exaggerates the condition. Infants 
who are nursed at four-hour intervals rarely suffer 
from colic, while infants fed on a too frequent or 
irregular schedule are very apt to suffer from in- 
digestion, as the stomach is many times not empty 
from one meal until another is taken. 

On the other hand, infants who are not receiving 
enough food frequently cry as if from colic. If the 
stools are small and the infant is not gaining in 
weight it is presumably not getting sufficient food. 
The amount of food a breast-fed infant receives 
can be accurately determined by weighing before 
and after each nursing. 

Soothing Syrups. Soothing syrups should 
never be given unless prescribed by a physician. 
They frequently contain opium and are especially 
dangerous in young infants. 



X 

DIET FOR CHILDREN FROM ONE TO 
TWO YEARS 

6 a.m. One or two tablespoons oatmeal, cream of wheat 
or other cereal, well cooked and served with 
milk and a very little sugar. Eight ounces of 
milk. 

9 a.m. One or two ounces orange juice diluted with an 

equal amount of water. 
10 a.m. One or two slices of toast, zweibach or rusk, 
soaked up with milk or beef juice. Six to 
eight ounces of milk. 

2 p.m. Eight to ten ounces good soup, to which has been 
added some rice and a little vegetable (car- 
rots, spinach, peas, potatoes). All should be 
put through a fine sieve and have the con- 
sistency of fairly thick gruel. 

In addition to this some bread and butter or toast. 

Two or three times weekly a part or all of a very 
soft boiled egg may be given. 

After twelve months a tablespoon of scraped rare 
broiled beef or mutton may be given in addition to 
a tablespoon of baked or mashed potato. Egg and 
scraped meat not on same day. The yolk of egg 
may have to be dispensed with, especially in children 

J is 



n6 INFANCY AND CHILDHOOD 

with exudative diathesis, that is, with a tendency to 
eczema. For dessert : — Apple sauce, prune pulp, 
or other stewed fruit from which the seeds have 
been removed. 

6 p.m. Dish of cereal, milk toast, boiled rice, sago or 
tapioca, cup of custard, eight ounces of milk. 
When egg has been given for dinner custard 
should not be given on the same day. 

When children are constipated, particularly when 
the stools are hard and dry, bread and plenty of 
vegetables and stewed fruit should be given. 

In some cases where the constipation is persistent 
the milk may be diminished to advantage. Children 
should have nothing between meals but water, which 
should be allowed freely. 

The water may be cool, but ice water never should 
be given to children. 

DIET FOR OLDER CHILDREN, AFTER THE 
SECOND YEAR 

The importance of proper diet in older children 
cannot be too greatly emphasized. 

It is a comparatively simple problem for the 
mother or nurse to restrict the diet of infants up to 
two or three years. In older children, however, and 
particularly those of a nervous temperament, it re- 
quires sound judgment and great firmness. 

In case of the average child, it will be well now- 



DIET FOR CHILDREN 117 

ished, or badly nourished, depending upon the char- 
acter of the food it eats. 

The diet should consist of plain, substantial food 
with a proper balance of fat, proteid, starch and 
sugar. 

To say that a child will not eat this or that is 
absurd. A child will eat anything in reason that 
is put before it, if it has the proper discipline and 
is hungry enough. The old adage " hunger is the 
best cook " applies equally to children and adults. 

It is not uncommon to hear a mother say, " My 
child cannot eat such and such a thing, and I never 
could myself." One could hardly expect a child to 
take a different attitude from that of its mother. 
Such an attitude is not, however, inherited, but 
acquired. 

If children are allowed to choose their own food 
it is perfectly natural for them to eliminate the plain 
food, which is absolutely essential to their develop- 
ment, and choose only those things which tickle their 
palates, that is, the sweet things. Whenever sweet 
things are given, which should be in very limited 
quantities, they should always come in the form of 
a dessert, after the meal and only when the plain 
food has all been eaten. 

After the second year, milk is not so essential an 
article of diet as is generally supposed. 

Milk is designed for the very young, and among 



iiS INFANCY AND CHILDHOOD 

the lower animals there are none, so far as the author 
knows, who receive milk from the mother after they 
reach the age of one year. 

Milk is, however, an important article of diet, but 
in older children it does not take the place of a gen- 
eral mixed diet. Children after one year whose 
diet is made up too largely of milk are almost in- 
variably poorly nourished. 

Drinking Milk Between Meals. Drinking 
milk or eating between meals destroys the appetite 
and results in insufficient food being taken at the 
meals. Unless there is some contraindication to its 
use, milk should be taken with the meals. 

The following diet would be appropriate for the 
average child of from two to five years : 

Breakfast, at 7 130 A.M. 

Juice or pulp of half an orange. 

A dish of thoroughly cooked oatmeal, or other 
plain cereal, served with some milk and very little 
sugar. 

Soft egg every other day, boiled or poached 
(never fried), or a slice or two of crisp bacon. 

Toast or graham bread and butter. 

Cup of milk or weak cocoa. 

Dinner, 12 M. 

Cup of soup (any good meat stock), to this may 
be added rice or barley and some of the vegetables. 



DIET FOR CHILDREN 119 

Mutton chop, steak, chicken, or fresh fish broiled 
and finely chopped or ground. 

One of the following vegetables: Potato (baked 
or mashed), carrots, spinach, peas, beans, celery, as- 
paragus tips, squash, all well cooked and finely 
mashed. 

Bread and butter, or rice. 

FOR DESSERT 

Stewed fruit (very little sugar), such as apple 
sauce, baked apple, stewed prunes, peaches, pears, 
strawberries, pineapple, etc., or some simple pud- 
ding, such as bread pudding, sago, tapioca, rice, cus- 
tard, corn starch, etc. 

At 4 P.M. 

If hungry and the child is having plenty of exer- 
cise in the open, a graham cracker or two, or a 
piece of bread and butter, may be given. If it is 
found that such a lunch destroys the appetite for 
supper, it should be discontinued. 

SUPPER 
At 5:30 P.M. 

Milk toast or cereal, custard, stewed fruit, bread 
and milk. 

The heavy meal should be given in the middle of 
the day and a light meal at bedtime. 

Tea and coffee should not be given to children. 



120 INFANCY AND CHILDHOOD 

The milk and cocoa should be given warm. All 
milk should be boiled. 

SIMPLE ARTICLES OF FOOD AND THEIR 
CALORIC VALUES 

The caloric need of a growing child after two 
years is about 30 calories per pound of body weight. 
A child of three years, therefore, weighing 35 
pounds, would need approximately 1000 calories to 
maintain its body weight. If it is having vigorous 
exercise and is out-of-doors much in cold weather, 
its needs would be considerably greater. 

The caloric or food value of the following simple 
articles of diet may be of practical value in deter- 
mining the quantity of food needed in an individual 
case : 

Food Values 

1 qt. whole milk 670 calories 

I qt. skimmed milk 350 calories 

1 qt. buttermilk 350 calories 

1 pt. skimmed cream 860 calories 

Bread, 1 slice, 3 by 4 inches, y 2 inch thick . . 100 calories 

Toast, 1 slice, same size 100 calories 

Zweibach, 1 piece equals y 2 slice bread 60 calories 

Soda crackers, ordinary size, 3 to 1 oz 120 calories 

Graham crackers, 3 to 1 oz 120 calories 

Cooked cereals, such as oatmeal, cream-of- 
wheat, rice, mashed potatoes, macaroni, 1 

tablespoon 30 calories 

1 egg 75 calories 

Cane sugar, 3 tablespoons — 1 oz 120 calories 



DIET FOR CHILDREN 121 

Loaf sugar, 3 large dominoes, or 6 small ones 
— 1 oz 120 calories 

Green vegetables, cooked and mashed, peas, 
beans, carrots, spinach, 1 heaping table- 
spoon — about 30 calories 

If butter is added the value is much greater. 

Butter, y 2 oz. — 1 in. cube 130 calories 

Broth, or beef juice, 1 oz 7 calories 



XI 

EXERCISE FOR INFANTS 

Exercise is absolutely essential to the proper 
growth and development of an infant. A young 
infant gets exercise by crying and by moving its 
arms and legs. 

Morning and evening, at least for a period of 
fifteen or twenty minutes, the baby should be placed 
upon a bed, undressed and allowed to kick and move 
its hands and arms as much as it pleases. All 
clothing which restrains the movements should be 
removed. Later, a mattress or folded blanket put 
upon the floor and surrounded by a " nursery pen " 
is a convenient way of allowing the baby all the ex- 
ercise of which it is capable. (See page 56.) 

After a child is old enough to run it should be 
allowed to play about outside, both winter and sum- 
mer several hours a day. (See page 54.) 

Children are frequently pushed about in a car- 
riage, or taken in automobiles, when they would be 
much better off playing in their own yards. Chil- 
dren need fresh air, but they need a proper com- 

122 



EXERCISE 123 

bination of both exercise and fresh air. Children 
will usually sit up, stand, walk, etc., as soon as their 
muscles are sufficiently strong to permit them to do 
so. All these movements should be voluntary and 
should not be forced upon them by mechanical de- 
vices, otherwise some serious deformity may result. 
Every case of bow-legs is a case of rickets. 

EXERCISE FOR OLDER CHILDREN 

In order that older children may develop prop- 
erly it is also essential that they have a large amount 
of exercise in the open. That the different muscles 
of the body be brought properly into play a great 
variety of movements are necessary. 

Children who romp about with each other, run- 
ning, swinging, turning somersaults, throwing ball, 
wrestling and a thousand other things, exercise 
most of their muscles. 

It is pathetic to see children being walked about 
the streets by a governess or being taken to school 
in a limousine, when they should be running and 
playing on the w T ay with other children. If such 
children later disappoint their parents, the fault will 
not be wholly theirs. (See page 54.) 

Children who are hollow-chested and have a 
tendency to be round shouldered should have special 
exercises designed to develop the chest and back 
muscles. These exercises should be accompanied 



124 INFANCY AND CHILDHOOD 

by systematic deep breathing. No shoulder straps 
are necessary. 

Such children should attend a gymnasium two 
or three times weekly, and the exercises be kept up 
at home in the interval. 

Many times curvature of the spine is produced by 
bad positions while sitting at the desk in school. 
Accompanying illustrations illustrate well this point. 




Wrong 



Wrong 



Children with beginning deformities of the chest 
or of any of the bones should consult an orthopedic 
surgeon, as much can be done by posture and ap- 
pliances to prevent further deformity and correct 
that already present. 



XII 

DISEASES OF THE RESPIRATORY 
TRACT 

COLD IN THE HEAD. CORYZA. SNIFFLES 

Catarrhal inflammation of the nasal passages is 
perhaps the most common affection of infants and 
children. Babies a few days, old suffer from 
sniffles. The disease is often* contagious and is 
readily communicated from one to- the other by close 
contact. If one infant in a small ward has a cold 
in the head, the others are almost sure to get it un- 
less they are kept far apart. 

There is often considerable fever and it is not 
infrequent that the inflammation extends to the 
larynx and bronchi. 

One of the most distressing symptoms is the 
blocking of the nose and consequent inability to 
nurse. 

Sniffles is an early symptom of inherited syphilis. 
Persistent sniffles, accompanied by a rash, is always 
significant in a young baby. 

Where the nasal passages are blocked, in simple 
125 



126 INFANCY AND CHILDHOOD 

coryza, adrenalin ointment will often give much 
relief. 

SPASMODIC CROUP 

Croup is a spasm of the upper air passage 
(larynx), manifested by a hoarse cough and difficult 
breathing (particularly on inspiration). It may be 
produced by some inflammation of the upper air 
passage (taking cold) and is usually much exag- 
gerated at night. A child will frequently seem 
well when it goes to sleep and will suddenly waken 
with an attack of croup. Children who are prone 
to convulsions are liable to suffer from spasmodic 
croup. 

Spasmodic croup is rarely dangerous, but it is 
most terrifying to the mother. 

There is still much confusion in the public mind 
between " spasmodic croup " and " membranous 
croup" (diphtheria). (Page 134.) If a croup 
persists for more than a few hours, a physician 
should always be consulted, as what is believed to 
be a spasmodic croup may later prove to be a mem- 
branous croup (diphtheria). 

Treatment. The room should be kept warm 
and the air moistened by a steam kettle to which 
some tincture of benzoine has been added (teaspoon 
to pint water). A cold pack or ice bag should be 
applied to the front of the throat. If the difficulty 



DISEASES OF RESPIRATORY TRACT 127 

in breathing is great, one-half to one teaspoon of 
syr. ipicac may be given, which will usually be fol- 
lowed by vomiting and relief. The child should 
be kept inside, out of the wind and dust, until the 
symptoms have disappeared. 

BRONCHITIS 

Bronchitis is a frequent affection of childhood. 
Some children are particularly prone to attacks 
which come one after another without any apparent 
cause. Some of the most common predisposing 
causes to bronchitis are: over-heated houses, espe- 
cially when the air is too dry; too warm clothing, 
especially when in the house; insufficient fresh air. 
When infants or children who live in superheated 
houses or flats are taken in winter into the open air 
they are prone to infections of the respiratory tract. 

Babies, on the other hand, should never be put 
out to sleep at zero and below zero temperature. 
While they need a maximum of fresh air, it must be 
remembered that warmed fresh air is just as pure as 
cold fresh air, and that warmed fresh air at a tem- 
perature of 40 to 50 F. is much less liable to pro- 
duce irritation of the respiratory tract than fresh air 
at zero or below zero temperatures. 

Mouth Breathing Due to Adenoids as Caus- 
ing Bronchitis. Mouth breathing due to ade- 
noids is a common cause of bronchitis. Children 



128 INFANCY AND CHILDHOOD 

will frequently cough and have more or less throat 
and bronchial irritation as long as they continue to 
breathe through the mouth. 

Many times bronchitis occurs in epidemic form 
and is readily contracted from coming in contact 
with others who have it. This form frequently be- 



Simplex Vaporizer 

A. Cotton Cone 

B. Cup 

C. Water Boiler 

D. Alcohol Lamp 

gins as a catarrhal inflammation in the nose and 
throat and gradually extends to the bronchi. It is 
usually attended by fever. 

Simple bronchitis is best treated by maintaining 
a uniform temperature 6o° to yo° F. and by keep- 
ing the air moist with some steam with the addition 
of tinct. benzoin (teaspoon to pint of water) al- 



DISEASES OF RESPIRATORY TRACT 129 

lowed to simmer over a gas or alcohol flame or on 
the stove. Fresh air should be admitted constantly. 

Exposing infants or children with bronchial affec- 
tions to zero temperatures is a dangerous proceed- 
ing and has nothing to commend it. 

Local applications to the chest wall, in the form of 




A Simple Arrangement for Steaming Which Can Be Fitted 
to the Child's Bed 



packs, mustard plasters, warm oil, etc., are un- 
doubtedly of some benefit. 

Care must be taken in giving cough syrups unless 
they are prescribed by a physician, as they fre- 
quently contain opium, and it must be remembered 
that infants are particularly susceptible to opium in 
any form. 



130 INFANCY AND CHILDHOOD 

PNEUMONIA 

Pneumonia is an inflammation of the lungs in 
which a portion of the lung becomes " solid.'' 
Pneumonia is usually divided into two classes : 

Lobar pneumonia. 
Broncho pneumonia. 

Lobar pneumonia is often limited to a portion 
(lobe) of one lung. The onset is usually sudden, 
beginning with a chill, or, not infrequently in in- 
fants, with a convulsion. The breathing is hard 
and catchy and the inspiration usually accompanied 
by a grunt. The fever remains high throughout the 
course of the disease. 

The disease, as a rule, runs a rapid course of 
from five to nine days and ends usually by a crisis, 
the temperature dropping to normal within a few 
hours. The drop in temperature is generally ac- 
companied by an improvement of all the symptoms. 

Lobar pneumonia is a serious and dangerous 
affection, and a physician should always be in at- 
tendance. 

BRONCHO PNEUMONIA 

Broncho pneumonia accompanies a general bron- 
chitis. There may be numerous small areas of 
consolidation in the lungs. The disease may be se- 



DISEASES OF RESPIRATORY TRACT 131 

vere or mild, and usually ends by lysis, that is, the 
symptoms subside gradually. 

A bronchitis which is accompanied with high 
fever is likely to be a broncho pneumonia. 

In the case of pneumonia, as in bronchitis, fresh 
air is of the greatest importance. It must be again 
remembered that fresh air is not necessarily cold 
air. 

GRIPPE (INFLUENZA) 

Grippe is an acute infectious disease, extremely 
common in children. It is readily communicated 
from one person to the other, frequently by kissing. 

The disease is characterized by inflammation of 
the mucous membranes of the respiratory and diges- 
tive tracts. 

An extension of the infection to any of the or- 
gans of the body may occur. 

Pneumonia is a common complication and in 
young infants it is followed many times by serious 
results. 

Extension of the inflammation to the middle ear 
and the other sinuses is common. A physician 
should always be in attendance. 



XIII 

THE CONTAGIOUS DISEASES 

The diseases which are generally considered as 
belonging to this list are as follows : 

Tuberculosis, 

Diphtheria, 

Scarlet fever, 

Measles, 

German Measles, 

Smallpox, 

Chicken pox, 

Mumps, 

Whooping cough, 

Erysipelas, 

Gonorrhea, 

Syphilis, 

Many of the forms of tonsilitis, nasal, and bron- 
chial infections, etc. 

Such diseases as typhoid fever may also be con- 
tagious under certain conditions. 

TUBERCULOSIS 

Tuberculosis is a disease produced by the tubercle 
bacillus. It gains entrance to the body usually 

132 



THE CONTAGIOUS DISEASES 133 

either through the respiratory or digestive tracts. 

The disease is not usually inherited, but a certain 
predisposition to it may be. The most common 
way in which a child contracts the disease is by 
direct contact with some one who has it. This may 
be the mother or some other member of the family. 
Since the lungs are a common location of the dis- 
ease the sputum is usually loaded with the tubercle 
bacilli. The greatest care must therefore be taken 
lest a mother or attendant who is suffering from 
tuberculosis infect the baby. The writer recently 
saw a whole family of children who had been in- 
fected in this way. 

The locations most commonly involved are: the 
glands, the bones, the lungs, and the coverings of 
the brain and spinal cord. Milk, according to many 
authorities, is a frequent source of tuberculosis in 
infants. The frequency with which milk-cows 
suffer from the disease, makes the milk a probable 
source of infection. 

Eighty per cent, of adults at some time during 
their lives have been infected to some degree with 
tuberculosis. This does not mean that all of 
them have had active tuberculosis. Many of them 
overcome the infection before it produces symp- 
toms. 

So much can be done for tuberculosis patients 
during the early stages of the disease, and often so 



134 INFANCY AND CHILDHOOD 

little later, that it is of the utmost importance that 
the diagnosis be made early. 

All persistent coughs accompanied by fever and 
loss of weight, glandular enlargements, distention 
of the abdomen which is not relieved after a cathar- 
tic, painful joints, particularly the knee and hip 
joints, should be viewed with suspicion, and the 
advice of a physician sought at once. 

All discharges from the nose and throat of 
patients suffering from tuberculosis of the throat 
and lungs should be destroyed. The stools are also 
possible sources of infection. 

Mothers suffering from tuberculosis in any form 
should not nurse their babies. The nursing exposes 
the baby to infection and reduces the mother's 
vitality, thereby lessening her chance of recovery. 

DIPHTHERIA 

Diphtheria is a disease characterized by inflam- 
mation and the formation of a false membrane, 
usually in the upper air passages, and severe gen- 
eral poisoning of the system. The disease is pro- 
duced by the diphtheria bacillus. 

The discharges from the mouth and nose contain 
the germs of the disease. 

The time necessary to contract the disease after 
the infection enters the throat is from twenty-four 
hours to several days. 



THE CONTAGIOUS DISEASES 135 

Diphtheria has been known since time im- 
memorial, but it is only during the past thirty years 
that it has been possible to differentiate it from 
other affections of the throat, tonsilitis, spasmodic 
croup, etc. 

The death rate varies much in the different 
epidemics, but before the days of antitoxin it 
was frequently as high as thirty-five to fifty per 
cent. 

Since the discovery by Behring of antitoxin the 
death rate is not now over six to ten per cent. 

The disease usually begins suddenly with sore 
throat, vomiting and fever. The infection most 
frequently begins with the formation of membrane 
on one or both tonsils. The disease, however, may 
begin first in the nose or in the larynx. All cases of 
sore throat with membrane or of croup which does 
not subside in a few hours should be seen by a 
physician. 

The chances for recovery from diphtheria de- 
pend upon the earliness with which antitoxin is 
given. 

If antitoxin is given within the first twenty-four 
hours the death rate is zero. 

If delayed until thirty-six or forty-eight hours 
the death rate jumps to six or eight per cent., and 
after this it rapidly increases. 

It is criminal, in the light of our present knowl- 



136 INFANCY AND CHILDHOOD 

edge, for a parent or guardian to refuse or neglect 
to have a child suffering from diphtheria given anti- 
toxin. 

I have seen the death rate, in the City and County 
Hospital in St. Paul, diminished by the use of anti- 
toxin from thirty-five to six per cent.; and this is 
an institution where only the severest cases are 
sent for treatment. 

The worst thing which will happen as a result 
of a dose of antitoxin is a " crop of hives/' which 
may be inconvenient, but not dangerous. 

Antitoxin does not produce paralysis, as is fre- 
quently believed. The paralysis is produced by 
diphtheria poison which was formed before the anti- 
toxin was given. 

A too frequent mistake is made in allowing a sore 
throat to go for several days without calling a 
physician, believing the child to be suffering from 
tonsilitis. 

In many cases where there is a membrane in the 
throat there is no way of telling whether it is diph- 
theria or a simple tonsilitis, except by making a cul- 
ture or by examining some of the membrane under 
the microscope. 

// all cases of membranous sore throat were at 
first assumed by the mother to be diphtheria, and a 
physician called, there would be very few deaths 
from diphtheria. 



THE CONTAGIOUS DISEASES 137 

Antitoxin should always be given, even in the 
cases which are apparently mild. 

Diphtheria patients should be kept in the recum- 
bent position for several weeks, as the most frequent 
cause of death is heart paralysis. 

The danger of paralysis of the heart muscle, as 
well as that of other muscles, is not past when the 
throat symptoms disappear. The danger perhaps is 
greater during the second and third weeks than dur- 
ing the first. The pulse should be taken daily by 
a trained attendant, and in case there is much varia- 
tion in the rate, or if the pulse should become slow 
or intermittent, the physician should be summoned 
at once. 

Sitting up in bed suddenly is not infrequently fol- 
lowed by sudden death in cases where the heart is 
weak, even where the child to all outward appear- 
ance is well 

It is always difficult to convince parents that a 
dangerous heart affection exists when the child 
seems otherwise perfectly well. It is frequently 
necessary to have the physician demonstrate the dif- 
ference between the pulse of a well child and that 
of the sick one, and to show the mother the differ- 
ence in the location and size of the heart. 

In membranous croup (laryngeal diphtheria) 
the membrane forms in the larynx or extends from 



138 INFANCY AND CHILDHOOD 

the throat to the larynx, the added danger of course 
being the blocking of the passage to air. 

These are serious cases and demand constant 
watching. The child should be placed in a steam 
tent, and, if possible, should be sent to a hospital, 
where, in case of a serious blockade in the air pas- 
sage, a tube may be introduced and the child's life 
saved thereby. 

During an epidemic of diphtheria, as well as of 
any other contagious disease, boil all milk. Con- 
tagious disease follows altogether too frequently 
in the wake of the milk wagon. 

scarlet fever 

Scarlet fever is an acute contagious disease char- 
acterized by the sudden onset of vomiting, fever, 
sore throat (frequently with membrane), and the 
appearance on the skin of a fine, characteristic rash, 
scarlet in color. 

The cause of the disease is as yet unknown, but 
the constant appearance of a certain organism in 
the throat (streptococcus) makes it probable that 
that is the exciting cause. 

All secretions from the throat, nose, and ears 
are undoubtedly infectious, as well as the urine and 
the stools. The time required after exposure until 
symptoms appear is from one to five days. The 



THE CONTAGIOUS DISEASES 139 

disease varies much in severity in individuals, as 
well as in the different epidemics. 

Because one child in a family has the disease in 
a light form is no reason why another child in the 
same family may not have a malignant attack. 

No child should ever be exposed to scarlet fever 
with the idea that he " is bound to get it sometime" 

Scarlet fever must always be regarded as a se- 
rious disease and one capable of producing grave 
and permanent changes in different organs of the 
body. 

The disease itself may be virulent enough to pro- 
duce death during the first few days. 

The glands of the neck often become involved and 
not infrequently break down and form abscesses. 
Middle ear abscess is of common occurrence and 
may be followed by a chronic discharge, with im- 
paired hearing. 

Acute inflammation of the kidneys, with partial 
or complete suppression of urine, is a frequent and 
dangerous complication. The kidney changes, even 
if the patient recovers, are liable to be more or less 
permanent. 

When scarlet fever is suspected a physician 
should always be consulted. 

Even in mild cases the urine should be examined 
occasionally, even several weeks after the patient 
is apparently well. 



:_: : 7 : : zyzjzyz :: 



i vsriii.i :::r.t. 
' is '. ::.z 15 litre 

± 5::-::::r :..t 



V"~ 1 v" 






THE CONTAGIOUS DISEASES 141 

The diet should be light, the bowels kept free, and 
plenty of water given. In uncomplicated cases no 

rr.±i:::~t is retuirei 

GERMAN MZASLZS 
A disease characterized by a. ra.sh resembling 
measles. There are very few general symptoms. 
S:~e::~ts slight it tr z.rA s::e thr:ai The 
glands behind the ear are liable to be somewhat en- 
larged The patient should be kept in bed for a 
day or so and fed lightly and the bowels kept open. 



SMALLPOX 

Li 



vere general symptoms : headache, pain in the back 

£.r.i leg's ir.c the i.zzt^ri.r.-.t z~ the shir. :: art eru> 
t:;r. tvh::h has a sh:try feelir.g :; the t:u:h. S::r. 
ea:h pazule he-: trr.es :^;:tl ~i:h a pustule. 

In severe cases these lusrules are so thickly 
crowded together that they form, when they dry, 
dense crusts. The disease is frequently fatal un- 
less the patient has been successful/ vaccinated. 
See chapter :r. Va:::r.i:::r..i 

CHICKEN POX 

An acute contagious disease characterized by 
fever and general indisposition and on die skin by 
an eruption which, unlike smallpox, has a vesicle 
full of serum instead of pus. In some cases it is 



142 INFANCY AND CHILDHOOD 

difficult to tell whether the disease is chicken pox or 
a mild smallpox. A physician should always be 
called in order to make a diagnosis. 

MUMPS 

A contagious disease characterized by some gen- 
eral symptoms : fever and indisposition and swelling 
of the parotid gland. The swelling is in front and 
below the ear; not infrequently the ear stands out 
from the head. The chief danger is the possibility 
of involvement of the testes in boys and the ovaries 
in girls. An inflammation of these organs may re- 
sult in the destruction of their function. Patients 
suffering from this disease should be kept in bed 
and be under the supervision of a physician. 

WHOOPING COUGH 

A contagious disease occurring usually in epi- 
demics, and characterized by spasmodic attacks of 
coughing, accompanied by difficult inspiration 
(whooping). 

Many cases of whooping cough never " whoop," 
so that it is difficult often to make a diagnosis. 

It is always suggestive of whooping cough when 
a child wakens two or three times during the night 
out of a sound sleep and has a paroxysm of cough- 
ing and does not cough at all in the interval. 

Whooping cough must be regarded as a serious 



THE CONTAGIOUS DISEASES 143 

disease. The death rate is high, especially in young 
and feeble children, in whom pneumonia is not an 
infrequent complication. 

Many children vomit with every paroxysm, and 
as a result become much depleted in health from 
lack of food. In these cases the food should be 
given in liquid form and rather frequently, every 
three or four hours. In many cases an adhesive 
strip, drawn rather tightly around the body at the 
level of the diaphragm, will prevent much of the 
regurgitation of food. 

In uncomplicated cases little is to be gained from 
medicine. Some of the simple cough mixtures will 
sometimes relieve the laryngeal and bronchial irrita- 
tion. There are hopes that in the near future some 
vaccine or serum may be found which will control 
the disease. 

The important things in the treatment are : fresh 
air and food. The more time the patients spend in 
the open air, the fewer paroxyms they will have. 
Many of the remedies common in use among the 
laity are harmful; such things as illuminating gas 
are dangerous to health. 

The characteristic cough persists for a variable 
period of from six weeks to several months. The 
disease, however, is probably not contagious after 
four or six weeks. 

If there is fever and any difficulty in breathing 



144 INFANCY AND CHILDHOOD 

between the paroxysms a physician should always 
be consulted. 

All children with whooping cough should observe 
quarantine for several weeks. 

ERYSIPELAS 

Erysipelas is an acute contagious disease charac- 
terized by a localized inflammation of the skin with 
marked tendency to spread by continuity. The in- 
fection is due to a streptococcus. 

The infection takes place usually through some 
wound, many times only a slight abrasion. It be- 
gins usually with a small red spot, which rapidly 
spreads in all directions. The infected area is in- 
tensely red and raised noticeably above the normal 
skin. 

The face is the most common seat of infection, 
but any part of the body may be involved. 

The affected area is swollen and edematous and 
frequently there are small blisters filled with serum 
on the surface. During the course of the disease, 
which lasts for a variable time, there is fever and 
much general prostration. 

There is a marked tendency to an inflammation 
of the kidneys. 

The disease is especially serious in young and 
feeble infants. 

A physician should be called at the onset. 



THE CONTAGIOUS DISEASES 145 

GONORRHEA 

A disease produced by the gonococcus. It is 
capable of producing an inflammation of almost any 
of the mucous membranes, but is particularly prone 
to involve the genito-urinary tract and the eyes. 

Perhaps as high as eighty per cent, of all cases of 
blindness are due to this disease. 

Many infants are infected at the time of birth 
from the mother's vaginal secretions. 

The disease is particularly contagious and is 
widely spread by means of soiled linen or utensils. 

Whenever a discharge appears, either from the 
eyes or the vagina or urethra, a physician should at 
once be consulted ; some of the discharge should be 
spread upon a glass slide, stained and examined un- 
der the microscope to determine the nature of the 
disease. 

When one or both eyes are infected with gon- 
orrhea the best medical aid possible should be 
sought. Irrigations and medication will be neces- 
sary every hour during the day and night. Even 
with the most thorough and heroic measures it is 
often impossible to save the sight. 

In case of gonorrheal infection of the genito- 
urinary tract in infants and children the utmost care 
will be required to prevent infection of the eyes by 
means of the hands. Irrigations and proper medi- 



146 INFANCY AND CHILDHOOD 

cation will be required extending over a period of 
many weeks, and perhaps months, before a complete 
cure results. 

SYPHILIS 

A venereal disease communicated from one to 
another by contact or by inheritance. 

Infants frequently have the disease at birth, al- 
though marked symptoms may not appear until the 
infant is several weeks old. 

One of the most common early symptoms is 
" sniffles " and the appearance of an eruption on the 
skin. The eruption, which is variable in character, 
usually involves the soles of the feet, the palms of 
the hands, and the skin around the mouth and 
anus. 

A physician should always be consulted and the 
truth told to him. If proper treatment is begun 
early and maintained for a sufficient time, many of 
these infants recover, to all appearances, completely. 
Where there is any doubt about the diagnosis a 
blood examination of both parents, as well as of the 
infant, should be made (Wassermann). 

The disease is very contagious and nurses should 
exercise great care not to become infected. 
Syphilitic children should always nurse their own 
mothers (never a wet nurse). If put on an arti- 
ficial food their chance of recovery is relatively 
small 



THE CONTAGIOUS DISEASES 147 

QUARANTINE 

When any member of a family is suffering from 
a contagious disease the parents are under moral 
obligation to themselves and to the community, 
even if not required by law, to maintain as thorough 
a quarantine as possible. 

It is surprising how zealous parents frequently 
are that strict quarantine shall be observed by every 
one but themselves. 

A child suffering from such a serious disease as 
diphtheria or scarlet fever should at once be isolated 
from other members of the family. If possible a 
nurse should be employed. It is always dangerous 
for the mother to undertake the care of the sick 
child and at the same time administer to the needs 
of other members of the family. 

A room should be selected as far removed from 
the others as possible, with a bath room in connec- 
tion. An open fireplace or wood stove is an im- 
portant adjunct to any sick room. 

All hangings and rugs should be removed. Toys 
and books should be limited to those which may be 
burned. 

All dishes and soiled clothing should be kept sep- 
arate and disinfected by boiling. 

A clean gown should be worn by the nurse or 
attendant and removed before leaving the room, 



148 INFANCY AND CHILDHOOD 

and the hands should always be washed thor- 
oughly. 

Milk bottles should always be boiled before re- 
turning them to the dairy. 

It is a mistake to expose children to any con- 
tagious disease with the idea that they are sure to 
get it sometime anyway. 

Such a disease as whooping cough, which is not 
usually quarantined by the departments of health, 
is attended by a large death rate, especially in young 
infants, and one is morally culpable if he exposes 
his own or other people's children to the disease. 

Time of Quarantine. There is no way of 
telling when many diseases cease to be contagious. 
It is therefore important to keep the child isolated 
long enough so that there is no longer any possibility 
of its carrying infection. 

DISINFECTION AND FUMIGATION 

Before a child who has had a contagious disease 
is allowed to mix with other members of the family, 
or community, it should have a thorough bath and 
shampoo and then be rubbed with alcohol or a 
1-2000 solution of bichloride of mercury. All toys 
and books should be burned. 

All clothing should be immersed for several hours 
in a carbolic acid solution, one ounce to two quarts 
of water. It may then be removed to the laundry 



THE CONTAGIOUS DISEASES 149 

and boiled. Such things as mattresses should be so 
arranged that they can be thoroughly fumigated. 

The windows and doors should be sealed and 
the room, charged with formaldehyde gas and al- 
lowed to remain closed for twenty-four hours. 

Formalin candles may be purchased at any drug 
store, with accompanying directions for their use. 
Where the department of health does the fumigat- 
ing it should be seen to that it is properly done. 

After the room has been opened the woodwork 
and walls should all be gone over with a solution 
of bichloride of mercury 1-1000, and if the walls 
are papered, repapering should be done, if possible. 
These last precautions are to be observed especially 
in scarlet fever. 



XIV 

MISCELLANEOUS 

MELENA NEONATORUM (BLEEDING OF THE 
NEW BORN) 

Bleeding in the new-born infant may occur from 
the cord or from any wound made by instruments 
or otherwise at birth. This is more apt to occur 
in bleeders or those in whom jaundice is present. 

The most common form of bleeding, however, is 
that which occurs from the stomach, in which the 
infant vomits blood, or from the bowel or urinary 
tract, in which blood is found in the urine and 
stools. The bleeding is apt to occur during the first 
few days after birth. 

The condition is serious, but not necessarily 
fatal. The administration of solutions of gelatin 
by mouth and hypodermically is often followed by 
cessation of the bleeding. It is frequently neces- 
sary to resort to the injection of blood serum, or 
even the transfusion of blood from some other per- 
son to the veins of the infant. 

No time should be lost in summoning a physician 
at the first appearance of bleeding in an infant, so 

150 



MISCELLANEOUS 151 

that proper treatment may be started at once ; other- 
wise many infants will succumb who might be 
saved. 

JAUNDICE OF THE NEW BORN 

Jaundice is a common affection of the new-born 
infant. In mild cases it has no special significance 
and after a week or two generally disappears. 

Extreme cases sometimes occur attended with 
fever and great prostration. This condition may 
result from infection of the navel. Where the 
jaundice is progressive and no fever is present there 
may be congenital absence of the bile ducts. 

CONVULSIONS 

Some infants are particularly prone to convul- 
sions. In these children every attack of indiges- 
tion, or the onset of any infection, is liable to be 
followed by a convulsion. Such children should be 
fed most carefully and always under a physician's 
directions, as much can be done by diet and other 
means to prevent their recurrence. When such at- 
tacks recur at intervals the possibility of epilepsy 
must always be considered. 

In all cases where a convulsion occurs, the bowels 
should be emptied as quickly as possible by a high 
enema, and as soon as practicable after the attack 
is over a dose of castor oil given. A physician 



152 INFANCY AND CHILDHOOD 

should always be sent for. All food should be 
withheld for twelve or twenty-four hours and only 
water given. 

A warm bath at 105 F. to which some mustard 
has been added will bring the blood to the surface 
and relieve the internal congestion. 

At the same time the head should be kept cool 
with cold cloths or an ice bag. 

If the temperature is high the child may be 
wrapped in a cool pack, made by wringing a large 
bath towel out of cool water, one-third alcohol. 
It should then be rolled in a blanket and the pack 
renewed when necessary. 

When hot baths are given, great care should be 
exercised that in the excitement the infant is not 
burned. Worms, teething, and adherent foreskin 
are overestimated as causes of convulsions. 

WORMS 

Intestinal worms occur rather frequently in chil- 
dren. They are not, however, nearly as frequent 
as generally supposed. 

They rarely occur until the infant has been put on 
a mixed diet. 

The varieties of worms which are common to 
children are the following: 

Round worm, two to three inches in length and 
the size of a small angle worm. 



MISCELLANEOUS 153 

Pin, or thread, worm, one-third to two-thirds of 
an inch in length and about the thickness of a No. 
36 thread. 

Tape worm, varying from three to ten feet in 
length and divided into small segments. 

These parasites enter the intestinal canal usually 
by means of the food. 

Eating uncooked meat is the common cause of 
tape worm. 

There are no definite symptoms which can be said 
to be characteristic. Such symptoms as grinding 
the teeth, picking the nose, restlessness in sleep, 
do occur in children who have worms, but they also 
occur from many other causes. 

When children are suspected of having worms 
they should be given a large dose of castor oil and 
the stools watched. If worms are present usually 
some will appear. If none appear and there is still 
doubt a specimen of the stool should be taken to a 
physician for examination. 

If worms are present in the intestinal canal eggs 
will be found under the microscope. 

Worm powders should never be given to children 
except when a definite diagnosis of worms has been 
made, and then only under a physician's direction. 

Not infrequently serious poisoning occurs by giv- 
ing worm-remedies and usually without any worms 
being present. 



154 INFANCY AND CHILDHOOD 

Round worms infest the small intestine prin- 
cipally. 

Pin, or thread, worms inhabit the lower part of 
the colon and rectum and occur in the stools in the 
form of tiny threads. They produce intense irrita- 
tion around the rectum. 

In girls they may gain access to the vagina and 
even the bladder. 

They are readily gotten rid of by emptying the 
lower bowel once daily for a week with an infusion 
of Quassia (i pint) and by keeping the child's 
hands tied so that it cannot scratch itself around the 
anus. 

If there is any possibility of contamination, 
the finger nails should be kept scrupulously clean, 
since by this means children may reinfect them- 
selves through the food over and over again. 

The presence of a tape worm may usually be de- 
termined by watching the stools for segments, par- 
ticularly after a brisk cathartic These sections 
should always be preserved in water and taken to 
the physician for examination. 

When a remedy has been given to expel the worm, 
care should be taken to preserve every part which 
comes away, for the physician's examination. If 
the head of the worm has not been expelled the 
worm will usually grow again. 



MISCELLANEOUS 



l DD 



ADENOIDS 

Every child has a certain amount of lymphoid 
or adenoid tissue in the throat behind the nose. 
When there is any marked increase in the amount 
of this tissue the child is said to have adenoids. As 
a result there is obstruction to breathing through the 
nose (the proper channel) and the child is compelled 
to breathe through the mouth (the improper chan- 
nel). 

In climates of extreme changes, probably one- 
third of all children have adenoids to some extent. 

It is not uncommon to see children with adenoids 
at birth. They cannot breathe through the nose and 
cannot as a consequence nurse properly until the 
obstruction has been removed. 

Children who have adenoids of any size, sleep with 
their mouths open, snore, and are restless in their 
sleep. The glands at the side of the neck are 
usually somewhat enlarged. Progressive deafness 
due to adenoids is common. Infection of the 
adenoid tissue frequently leads to inflammation of 
the middle ear, with the formation of an abscess. 

If mouth-breathing persists for any length of 
time the face and mouth become deformed and as- 
sume a typical appearance. There is usually some 
deformity of the chest-wall, due to improper 
breathing. In marked cases the mentality is slug- 



156 INFANCY AND CHILDHOOD 

gish, and as a result the children fall behind in their 
school work. 

Whenever there is persistent obstruction to the 
breathing through the nose that obstruction should 
be removed. 

The operation for the removal of adenoids is a 
simple one, involving little, if any, danger to life. 
In many cases it may be done without giving an 
anaesthetic. 

ENLARGED TONSILS 

Adenoids and enlarged tonsils frequently go to- 
gether. Many children, however, who have en- 
larged tonsils have no symptoms as a result. 

Moderately large tonsils causing no symptoms: 
sore throat, fever, or large glands at the angle of 
the jaw, do not require removal. It were well, 
however, if such children could be taught to gargle 
the throat daily, at bedtime, and at the same time 
brush their teeth with some simple alkaline solution, 
such as Seiler's Solution. 1 By this means particles 
of food would be prevented from collecting in the 
crypts of the tonsils, thereby producing more or 
less inflammation. 

Tonsils, however, which are enlarged and often 
inflamed, frequently contain pockets of pus which 
poisons the system and may, and often does, pro- 

1 Seiler's Tablets, under the name of Alkaline and Anti- 
septic Tablets, can be purchased at any drug store. 



MISCELLANEOUS 157 

duce serious complications, such as rheumatism and 
heart affections. Such tonsils should be removed as 
soon as possible after an attack. 

ENLARGED GLANDS 

Some children suffer at an early age from en- 
larged glands in the neck. These glands, varying 
in size from that of a pea to a hazel nut, may form 
a chain extending from the mastoid process to the 
clavicle (collar bone) ; or the glands at the angle 
of the jaw, on one or both sides, only may be en- 
larged. 

Formerly children with enlarged glands were said 
to be " strumous," and it was thought that prac- 
tically all enlarged glands were of tubercular origin. 

It is true that children of certain families are 
particularly prone to enlargement of the glands, but 
most of them are not tubercular. 

Many enlarged glands in the neck come as a direct 
result of infections from the throat. Children 
with enlarged tonsils and adenoids are very liable to 
have enlarged glands of the neck as a result of direct 
infection from these organs. After possible 
sources of infection from the throat have been re- 
moved the general nutrition of the child should be 
in every way improved. 

Sudden enlargement of the glands in the neck 
should always be followed by a careful examination 



158 INFANCY AND CHILDHOOD 

of the throat, in order that some serious infection, 
such as diphtheria, may not be overlooked. 

RHEUMATISM 

Inflammatory rheumatism is now believed to re- 
sult from an infection. The source of the infection 
may be unknown, but in many cases it is undoubt- 
edly from the throat and nose. Abscess of the ton- 
sils is a more frequent source of rheumatism than 
was formerly supposed. It does not, however, fol- 
low that every tonsil which is larger than normal 
should be removed. 

Children with inflammatory rheumatism are 
prone to suffer from some involvement of the heart, 
particularly of the valves and the serous covering 
(pericardium). Children who have any inflamma- 
tory involvement of the joints should remain in bed 
longer than may seem necessary, because of the 
possible heart involvement. Children with inflam- 
matory rheumatism should always be under the care 
of a physician and long after they are apparently 
well they should be taken occasionally for examina- 
tion. 

CHOREA (ST. VITUS' DANCE) 

This affection is not uncommon in children as 
they approach the age of puberty (maturity). The 
symptoms consist in involuntary movements of the 
voluntary muscles. In some cases these movements 



MISCELLANEOUS 159 

are so exaggerated as to absolutely incapacitate the 
child from walking or even from feeding itself. 
The bladder and bowel are rarely involved. This 
condition is sometimes attended by slight fever and 
not infrequently by pains in or about the joints. 
The frequency with which there is an involvement 
of the heart similar to that in rheumatism, has led 
many to believe that the diseases have a common 
origin. Children with chorea should always be un- 
der the care of a physician. 

Absolute rest and nutritious food are the two 
important factors in the treatment of this affection. 

EARACHE 

Earache usually occurs as a result of an infection 
of the middle ear, extending up the eustachian tube 
from the throat. When the inflammation is mild 
and there is no accumulation of fluid behind the 
drum, much relief may be gotten from dropping 
into the ear a solution of 2 per cent, carbolic acid 
in glycerine. If pain and temperature are persistent 
a physician should be consulted. Abscess of the 
middle ear in infants is of common occurrence. 

GOITER (THICK NECK) 

Goiter is an enlargement of the thyroid gland. 
The condition is common in girls at about the time 
of puberty. 



160 INFANCY AND CHILDHOOD 

Unless the enlargement is progressive and accom- 
panied by symptoms, such as shortness of breath, 
rapid heart, or some prominence of the eyes, it may 
be disregarded. In many cases the enlargement 
does not progress and even diminishes after adoles- 
cence is well established. In case there, are any 
symptoms which might be attributed to the goiter a 
physician should be consulted. 

CRETINISM 

Cretinism is an abnormal condition in infants, 
produced by a congenital deficiency of the thyroid 
secretion. The infant may seem perfectly normal 
at birth, but after a few months it is observed that 
it does not develop properly, although the food is 
adequate. 

The mental condition remains as undeveloped as 
the physical. 

The skin is dry and not infrequently covered by 
an abnormal amount of hair. The point of the 
tongue in many cases remains almost constantly 
between the lips. 

The long bones are all shorter than normal and 
the fingers present a stubby appearance. 

The treatment of this disease consists in supply- 
ing the necessary amount of thyroid extract, which 
is obtained from the thyroid gland of the sheep. 

If given in proper amounts, early and persistently, 



MISCELLANEOUS 161 

these children frequently develop almost normally. 

The treatment should always be given under the 
supervision of a physician, as it is quite possible to 
get marked and even dangerous symptoms from 
overdosing with Thyroid Extract. 

The administration of Thyroid Extract should be 
continued indefinitely, sometimes for life. 

RICKETS 

Rickets is a disease of nutrition produced usually 
by improper food. Artificially fed infants are par- 
ticularly prone to the disease, and especially those 
fed upon the patent foods, which are low in fat and 
proteid. 

Frequently the first symptom is sweating about 
the head. It will be noticed that after the baby 
awakens from sleep the pillow is wet with perspira- 
tion. It is restless, sleeps badly, and cries when 
lifted, as if from* pain. Not infrequently after a 
child has begun to walk it suddenly stops and makes 
no further effort in that direction, but sits, moving 
its legs, if at all, reluctantly. The most marked 
changes are in the bones, which are markedly lack- 
ing in lime salts. The bones, during rickets are 
particularly prone to deformity. The most obvious 
changes occur at the ends of the long bones, where 
growth is most active. This is most apparent at 
the wrists and at the junction of the ribs with the 



162 INFANCY AND CHILDHOOD 

sternum. Bowlegs are common in children who 
have rickets, and particularly if allowed to walk 
while the bones are soft. 

The square shape of the head is another charac- 
teristic symptom of rickets and delayed closure of 
the large fontanel is the rule. 

Children who have proper food and are well 
nourished will rarely develop rickets. Infants 
should receive breast milk, and after eight to nine 
months should have some additional food, such as 
beef juice, orange juice, and a little toast or other 
starchy food well cooked. Children who are 
forced to have artificial food should have properly 
modified cow's milk, with the addition, after five or 
six months, of beef juice, orange juice, and if they 
do not tolerate cream well, some cod liver oil or 
olive oil (one-half to one teaspoon three times 
daily). 

With the first evidence of rickets a physician 
should be consulted. Deformities are much more 
easily prevented than corrected. 

SCURVY 

Scurvy is a disease of nutrition due usually to the 
long continued use of some patent food or to milk 
which has been sterilized too long (boiled from 
twenty to thirty minutes). It practically never oc- 
curs in breast-fed infants. 



MISCELLANEOUS 163 

The symptoms are at first indefinite. The infant 
is pale, easily tired, sleeps badly, and frequently 
cries if the legs and arms are handled. Later 
there is bleeding into the gums around the teeth 
and there is often free bleeding if the gums are 
touched. There are frequently hemorrhages along 
the bones of the legs and arms, which often manifest 
themselves on the skin in the form of black and blue 
spots. 

Prevention. Breast-fed children practically 
never have scurvy. Children on sterilized foods 
should always have in addition, some uncooked fruit 
juice (orange juice). No other medication is 
necessary. 

HIVES. URTICARIA. NETTLE RASH 

Urticaria is characterized by an eruption on the 
skin consisting of circular or spiral elevations 
(wheels) scattered over various portions of the 
body. The color of the spots is usually a reddish 
pink, frequently with a white center. The size 
varies from one-eighth to several inches in diam- 
eter. 

Urticaria is frequently accompanied by gastro- 
intestinal disturbance and some rise in tempera- 
ture. 

Certain articles of diet, such as strawberries, eggs, 
shell fish, etc., frequently produce the eruption in 



i"64 INFANCY AND CHILDHOOD 

susceptible individuals. Such individuals are said 
to have an idiosyncrasy to these particular foods. 

The skin is usually intensely itchy and whenever 
scratched becomes red and slightly raised above the 
surface. 

Treatment. The intestinal canal should be 
emptied by a dose of castor oil and the suspected 
food eliminated from the diet. 

In relieving the intense itching sponging with a 
solution of soda is sometimes effective. It will, 
however, frequently be necessary to resort to some 
simple sedative, such as asafetida, until the toxic 
substance has been eliminated from the system. 

EXUDATIVE DIATHESIS. MILK CRUSTS. ECZEMA 

A considerable number of infants within the first 
few months after birth have a scaly condition of the 
scalp which to the ordinary observer resembles dirt. 
It is, however, an exudate, and when it is removed 
the skin underneath is inflamed. The more the sur- 
face is irritated by rubbing or scratching, the more 
serum is exuded and soon crusts are formed. Fre- 
quently pus forms under the crusts and the whole 
scalp rapidly becomes involved, and not infre- 
quently the face, hands, and in fact any part of the 
body. 

It is a mistaken idea that the breast milk is re- 
sponsible for the condition. The disease is inher- 



MISCELLANEOUS 165 

ited, but is much exaggerated by overfeeding, 
especially with fat. 

These cases should be kept on the breast, but not 
overfed. If they do badly on the breast they 
usually do worse on any other food. 

In bathing these children soap should be used as 
little as possible. The hands should be restrained 
so that the infant cannot scratch the skin, which is 
always intensely itchy; otherwise no treatment will 
have any effect. 1 

If the condition does not respond to simple reme- 
dies a physician should be consulted. The treat- 
ment must combine proper feeding with local ap- 
plications to the skin. 

A simple eczema may result from irritants, such 
as soap, without any constitutional cause. 

SPRU. THRUSH. STOMATITIS 

Spru, or Thrush, is an infection of the mucous 
membrane of the mouth, characterized by the ap- 
pearance of small white flecks which may be limited 
to the inside of the lips and cheeks, but not infre- 
quently also involves the tongue and roof of the 
mouth. 

Forcibly swabbing the mouth, or the continuous 

1 See article by the author, " Exudative Diathesis in its 
Relation to Infants." St. Paul Medical Journal, October, 
191 0. 



166 INFANCY AND CHILDHOOD 

sucking on a rubber nipple or pacifier, may predis- 
pose to this condition. 

A more severe form of infection, known as 
stomatitis, in which ulcers of the mucous membrane 
occur, is also common. 

Treatment. Remove all mechanical irrita- 
tion. It may be necessary to feed the infant from 
a spoon until the spots disappear. The mouth 
should be washed with a boric acid or boroglyceride 
solution after each feeding. If ulcers are present 
it may be necessary to have them cauterized. If 
the food is at fault it should be properly modified. 

SUMMER DIARRHOEA 

During the hot summer months many infants 
suffer from digestive disturbances of varying de- 
grees of severity. These attacks may be nothing 
more than a slight diarrhoea accompanied perhaps 
by vomiting and fever, or they may be so severe 
as to endanger the child's life. 

The death rate in infants during the hot weather 
is greatly increased, particularly in large cities. 
The most common causes of disturbances of the 
digestive tract during hot weather are : 

1. Artificial feeding. 

2. Overfeeding. 

3. Impure milk. 

4. Too much clothing. 



MISCELLANEOUS 167 

The death rate in artificially fed children is 8-10 
times as great as in children fed at the breast. 
The amount of food required for the body needs 
during the hot weather is much less than during cool 
weather. 

Dliring hot weather the chance for milk to un- 
dergo putrefactive changes is much greater than 
during cool weather. 

During hot weather infants should be dressed so 
that they are comfortable. The heavy woolen 
clothes should be removed, as infants do not stand 
extreme heat any better than they do extreme 
cold. 

When an infant begins to have any digestive dis- 
turbance, stop all food at once, and for twelve or 
twenty-four hours give only boiled water or a little 
barley, rice or oatmeal water. The bowels should 
be emptied by one or two teaspoonfuls of castor 
oil or other effective laxative, and the dose not re- 
peated. For several days following the food should 
be greatly restricted. The cream should be re- 
moved from the milk and only boiled skimmed milk 
given. If the stools are sour and green, all sugar 
should be left out and the food sweetened if neces- 
sary with saccharine (one tablet to pint of food). 
If the symptoms do not promptly subside a phy- 
sician should be consulted. 

Serious digestive disturbances attended by fever, 



168 INFANCY AND CHILDHOOD 

vomiting and diarrhoea and great prostration are 
never due to teething. 

VACCINATION 

The only means of modifying or preventing 
smallpox is by means of vaccination. 

When vaccination is carefully done, the vaccine 
pure, and the wound kept clean and covered until 
healed, serious results almost never occur. 

The area to be vaccinated should first be washed 
with alcohol or soap and water and then dried. 
After the skin has been scratched and the vaccine 
applied, the wound should be covered with a shield 
or sterile gauze. When the vaccination begins to 
" take " the dressing should be removed daily and 
the whole area, including the vesicle, washed with 
alcohol and the dressing reapplied. 

When serious infections occur it is always due to 
carelessness. 

When vaccination has " taken " it is usually not 
necessary to repeat the process within seven years. 
Usually the second vaccination will " take lightly " 
if the first "took well." 

If infants with eczema are vaccinated the greatest 
care must be taken to prevent them from scratching 
" the vaccination " ; otherwise it may be spread over 
the entire body, with fatal results. 

No child is too young to acquire smallpox, but 



MISCELLANEOUS 169 

since exposure may occur at any time infants should 
be vaccinated during the first year. 

KISSING 

Such diseases as diphtheria, syphilis, tuberculosis, 
etc., may be readily transmitted by kissing. 

Indiscriminate kissing should never be permitted, 
and when practiced the child should be kissed upon 
the cheek or forehead — never on the mouth. 

HABITS 

Infants as well as adults are creatures of habit. 
After habits have become fixed they are difficult 
to break. Since it is universally agreed that " an 
ounce of prevention is worth a pound of cure," in- 
fants should be allowed to form only good 
habits. 

There are certain bad habits to which infants 
and children are addicted, the most important of 
which are thumb-sucking, bed-wetting, dirt-eating, 
facial movements, masturbation. These symptoms 
may have for their cause some diseased condition, 
and if not promptly righted by simple means, a 
physician should be consulted. 

THUMB SUCKING 

The habit of thumb or finger sucking is of course 
a natural one, but it becomes a vice when persisted 



170 INFANCY AND CHILDHOOD 

in. As a result, the mouth is frequently the seat of 
irritation or other catarrhal inflammations, the 
fingers or thumbs are deformed, and the front upper 
teeth are not infrequently displaced. If the habit 
has not been allowed to persist for long it is not 
difficult of correction. 

To prevent the infant from sucking its thumbs 
or fingers the arms may be pinned to the sides, or 
cardboard splints applied at the elbow, allowing free 
movement but not permitting the hand to reach the 
mouth. 

The Pacifier. The pacifier habit is a vicious 
one and should never be permitted. The mucous 
membrane is constantly irritated by contact with the 
rubber. It is a frequent source of infection, as it is 
usually dirty. The glands of the mouth are stimu- 
lated so that there is a constant flow of saliva, with 
more or less digestive disturbance. The best way 
to correct the habit is not to begin it, and if al- 
ready formed, it should be stopped, even at the ex- 
pense of considerable loss of sleep on the part of 
the infant and the household generally. 

FACIAL MOVEMENTS 

The different facial movements, such as blinking, 
drawing up the upper lip, sniffling, jerking the head, 
etc., have frequently some local irritation which is 
responsible for their beginning. Blinking is usually 



MISCELLANEOUS 171 

caused by some irritation in the eyes or spas- 
mophilia ; drawing up of the lip, to some irritation 
in the nose. 

These habits should never be allowed to become 
fixed. The cause should be at once sought and re- 
moved. 

BED WETTING 

Bed wetting in older children is sometimes a 
habit, but more often a weakness for which the 
child cannot in any way be held responsible. 

When one can be sure that the cause is simply 
indifference, punishment may be efficacious ; other- 
wise it does more harm than good. When the 
trouble occurs only during sleep the child should 
have plenty of fluid during the earlier part of the 
day and the fluids restricted greatly from four 
o'clock on. The child should be taken up (actually 
awakened) at ten o'clock and again in the early 
morning, if necessary. The hours at which it is 
awakened should always be the same. An im- 
proper diet (too many sweets) is a frequent cause 
of bed wetting, by producing irritation in the blad- 
der and urethra from a concentrated urine. In- 
fection of the bladder due to the colon bacillus is a 
common cause of incontinence, especially in girls. 
In such cases a careful microscopic examination of 
the urine should always be made. Suspected ab- 



172 INFANCY AND CHILDHOOD 

normalities of the genital and urinary tract, as 
possible causes, should always be referred to the 
physician for diagnosis and treatment. 

MASTURBATION 

This is a habit which is rather common to both 
sexes. It consists of irritating the genital organs 
with the hands, the clothing, or not infrequently by 
rubbing the thighs together. Infants less than a 
year old acquire the habit, so that " peculiar move- 
ments," which are often passed by the nurse as 
" smart," should be carefully scrutinized. 

Any abnormal irritation about the genitals, lack 
of cleanliness, tight foreskin in boys, may be ex- 
citing causes. 

In older children the habit is frequently acquired 
from others who practice it. 

Young children should never be allowed to play 
together, or alone, without being observed. As 
soon as old enough to understand, children should 
be taught not to handle the genital organs, and given 
the reason why. 

In intelligent older children the habit is usually 
not difficult to break. 

Older children are not feeble-minded because 
they masturbate, but they may persistently mastur- 
bate because they are feeble-minded. 

In young infants it is necessary often to restrain 



MISCELLANEOUS 173 

the hands by 1r>' i r % them to the sides of the crib. or. 
if the irritation is produced by rubbing the thighs 

together, this may be overcome by any device v/hich 

will keep the legs apart Children should be ob- 

ved until they go to sleep and after they awaken. 

ve plaything should always be at hand. Chil- 
dren will play with something, and if there is noth- 
ing else at hand they are apt to play with their own 
organs. 

THE PROPER USE OF THE EYES 

That the eyes shall perform their proper function 
life, their care during infancy and ch: 
hood is of the greatest importance In yv 
children the long continued use of the e any 

one time should be avoided. So much depe 
upon the muscular control that over-taxing of the 
eye muscles should be avoided. 

The holding of picture books at improper angles 

an important cause of muscular strain. The 

reading of books while the child is lying down al- 

tys results in their being held at an improper 
angle, and should therefore be forbidden. 

The proper lighting of the play-room is of the 
greatest importance. Artificial light should be 
avoided whenever f It is. howev e r, much 

better to have artificial light, properly placed., than 
insufficient sunlight. 



174 INFANCY AND CHILDHOOD 

The windows in the play or schoolroom should 
be so arranged that the light comes in from behind 
or from above. Blackboards and charts should al- 
ways be arranged so as to be properly lighted, with- 
out having the light shine directly in the child's eyes. 
Any inflammation of the eyes should be reported to 
the physician if it does not promptly clear up, by 
the application of a simple wash, such as boric acid 
solution. 

ERRORS OF REFRACTION (DEFECTIVE VISION) 

Many children have defective vision from birth. 
These errors may be of various kinds and may to the 
ordinary observer be difficult or impossible of de- 
tection. The most common defects are the fol- 
lowing : 

Improper muscle control. 
Near sightedness. 
Far sightedness. 
Astigmatism. 

These errors are frequently not manifested by 
marked symptoms until a child reaches the school 
age, when inflammation of the eye-lids, headache, or 
other nervous symptoms should lead the parent to 
have the child's eyes examined by a competent ocu- 
list. 

The author has seen children so near sighted that 



MISCELLANEOUS 175 

they were thought to be defective mentally. A pair 
of properly adjusted glasses was all that was needed 
to restore them to the normal. 

MALNUTRITION. MARASMUS. SIMPLE 
ATROPHY 

Not infrequently infants who have been badly 
fed, particularly upon artificial food, develop a con- 
dition known to the laity as " marasmus." 

It often happens that the child is normal at 
birth and for a time, while on the breast, gains in 
weight. 

Owing to the advice of some well meaning but illy 
informed person, the baby is weaned and put 
on an artificial food. From this time on, the baby 
begins to go down hill. All kinds of foods are 
tried, with the same result. These infants, after a 
time, look like little old men and women. The 
face is pinched and wrinkled and the skin, which 
is pale and dry, hangs in folds on the extremities. 
The abdomen is usually distended. The stools are 
large and ill smelling. If there is no disease such 
as tuberculosis or syphilis in the background, these 
cases may entirely recover. 

The recovery will usually be slow, as a consider- 
able time must elapse before the normal power of 
digestion and assimilation of food can be reestab- 
lished. 



176 INFANCY AND CHILDHOOD 

Breast milk in these cases is of the greatest im- 
portance. If a wet nurse cannot be secured some 
breast milk should be procured and given the infant, 
combined with a properly modified diet adapted to 
its needs. 

These infants are particularly prone to infections 
of the skin, which appear in the form of boils. 
These should be opened at the proper time; other- 
wise they are liable to produce serious general in- 
fection. 

In addition to the food, fresh air and massage are 
valuable adjuncts in the treatment of these cases. 

DELICATE CHILDREN 

Not infrequently we meet children who have no 
particular disease but who are not well, and may be 
described as " delicate." Such a condition may be 
the result of bad inheritance or of a serious illness. 
More often, however, the condition is a direct result 
of bad feeding. 

A searching examination should be made in order 
to eliminate a possible tuberculosis in these cases. 

These children are prone to sit about and mope, 
take little exercise, and eat little at meals, with the 
exception of highly seasoned things and sweets. 

They should be kept in the open air much of the 
time and should have regular exercises, including 
deep breathing. The food should be of the plain- 



MISCELLANEOUS 



177 



est character. Eating between meals should be for- 
bidden and sweets should be practically eliminated. 

They should not be crowded at school, but should 
have regular duties to perform at home. 

A rest of an hour or so during the middle of the 
day should be insisted upon. This should come 




Simple Screened Bed for Out-Door Sleeping 

preferably after the noon day meal, which should be 
the hearty meal of the day. 

Change of climate, particularly sea or mountain 
air, will sometimes do much to start these children 
on the road to recovery. 



PUBERTY 

Puberty is the transition period between childhood 
iand adult life. 



i;8 INFANCY AND CHILDHOOD 

In girls there is usually a greatly increased 
growth both in weight and height, while in boys the 
gain both in weight and height is somewhat slower. 
After this period is passed the boys again forge 
ahead of the girls in both height and weight. 

The following evidences of the approach of pu- 
berty will be observed : 

In boys, a change of voice, beginning development 
of the beard, and a growth of hair under the arms 
and around the genitals. 

In girls, a rapid gain in weight and height, de- 
velopment of the breasts, growth of hair under the 
arms and around the genitals, and the beginning of 
menstruation (12 to 14 years). 

In warm climates and among southern races 
the age of puberty is rather earlier than in cold 
ones. 

During this period the nervous system in both 
sexes is prone to be unstable, so that the general 
health of children should be maintained at the high- 
est point. Many children are prone to sit around 
and read sentimental stories when they should be 
exercising in the open air. 

Irregularity of menstruation in young girls is fre- 
quently due to faulty conditions of living ( food, air, 
and exercise) . 

The old idea that girls are " sick" because they 
do not menstruate is putting the cart before the 



MISCELLANEOUS 179 

horse. They do not menstruate usually because 
they are already sick. 

A physician should always be consulted when any 
irregularities, either physical :: mental, develop. 
There is no time during the chiii's life when w an 
ounce of prevention " is so applicable as during the 
age of puberty. 

CLOTHING FOR OLDER CHILDREN 

The clothing for :i:er children should be sus- 
pended from the shoulders, bat not from the points 
of the shoulders. 

Properly made waists, with broad shoulder straps 
which come we'd up :: the base :: the neck, should 
be worn; upon these the stockings, drawers and 
tit users are suspended. 

A light woolen undershirt should be worn, even in 
the summer. Children are particularly prone to be- 
come overheated during play, and in the coolirr- 
off process they rarely use better judgment than do 
their older brothers and sisters. A woolen shirt 

D pi event many a cold and rob the doctor of many 
a fee. 

Since practically all houses are warm throughout 
the year, heavy ;i: thirty should never be worn in- 
doors. 

1 : v temperatures out of doors should be met by 
an adequate amount of outer clothing. 



180 INFANCY AND CHILDHOOD 

TOYS 

In selecting toys for babies one should always 
have in mind the fact that everything not too large 
goes promptly into the mouth. 

Toys which can be kept clean easily, without de- 
tachable points or sharp edges, should be chosen. 
Painted toys should never be purchased. 

Toys for older children should be selected not 
only as a means of amusement but also for their 
educational and disciplinary value. Plenty of 
wooden blocks of all sizes, from which the simplest 
to the most complex structures may be erected, are 
among the best. In addition, figures of people and 
domestic animals make a combination which gives 
endless play to the imagination and call forth real 
constructive ability. 

The complicated mechanical toys have little real 
value ; children quickly tire of them and nothing re- 
mains but the desire to take them apart in order to 
see what makes them go. 

For girls, miniature houses with proper furnish- 
ings and cooking utensils, inhabited by dolls of 
various sizes, offer a wide and important field. 

Children should never have many toys at a time, 
but should be allowed to exhaust the possibilities of 
one before another is given. 

Habits acquired during the first five years are the 



MISCELLANEOUS 181 

ones that abide. Children should therefore be re- 
quired to put their toys away in some convenient 
but stated place when they are through with them. 

Their garden tools, as well as wagons, carts, 
etc., should be put in a shed when the day's work 
is done. 

There is no better way of acquiring the habit of 
orderliness and concentration than by the proper 
use and care of well chosen toys. The effects 
of this training will influence the whole char- 
acter. 

FOREIGN BODIES 

When foreign bodies, such as buttons, pennies, 
etc., have been swallowed there is nothing to be done 
but watch the stools to see when they come through. 
This usually requires from three to seven days. 
Cathartics should never be given. Solid food, such 
as bread and potato, will often surround the object 
and lessen the irritation which sharp edges might 
otherwise produce. 

When foreign bodies are stuck into the nose or 
ears an effort may be made to remove them, but un- 
less great care is taken serious injury to the tissues 
may result. 

It is usually better to take the child at once to a 
physician, and if the object cannot be otherwise 
located an X-ray picture should be made. 



1 82 INFANCY AND CHILDHOOD 

ENLARGEMENT OF THE BREASTS IN INFANTS 
(WITCHES MILK) 

Occasionally new-born infants of both sexes have 
an enlargement of the breasts, with the secretion of 
a fluid resembling milk. 

The condition is a harmless one and soon becomes 
normal if left alone. Massage and manipulation 
only do harm and may, if persisted in, produce a 
rather severe local inflammation. 

CARE OF WOUNDS 

Any wound, no matter how simple, may be fol- 
lowed by infection. That this does not usually 
occur is because most germs are not disease-produc- 
ing and also because nature makes a strong re- 
sistance to all forms of infection. 

It is important that every abrasion or cut be 
thoroughly cleansed. This can best be done with 
normal salt solution (one level teaspoon common 
salt to pint of boiled water). After the wound is 
clean it should be covered with sterilized gauze until 
healed. Freshly ironed clean linen is practically 
sterile. 

The most dangerous simple wounds are what are 
known as punctured wounds. Such wounds are 
frequently received by children stepping on a nail. 
These wounds are not infrequently followed by 
tetanus (lock-jaw). The reason for this is that the 



MISCELLANEOUS 183 

tetanus bacillus is frequently found in garden earth 
and horse manure. A wound received from step- 
ping on a nail introduces the tetanus bacillus and 
when the nail is withdrawn the wound immediately 
closes, producing ideal conditions for the growth of 
the bacillus. 

A child receiving such a wound should be taken at 
once to a physician and the wound should be thor- 
oughly washed out and cauterized. 

Wounds received from toy pistols are also fol- 
lowed frequently by tetanus because the " wads " 
in the cartridge are made from waste paper picked 
from the streets and frequently contain tetanus 
bacilli. If there is any probability that these 
wounds have not been thoroughly cleansed an in- 
jection of " tetanus anti-toxin " should be given at 
once. This serum is useless if given after the dis- 
ease has developed. 

Hemorrhage from wounds may usually be con- 
trolled temporarily by the application of pressure, 
or if on the extremities by a tight bandage or 
tourniquet above the wound. 

MILK, FOR TRAVELING 

For artificially fed infants the preparation of the 
milk for a railway journey of several days is not 
nearly so difficult as is generally supposed. For the 
first twenty- four hours of the journey the milk may 



184 INFANCY AND CHILDHOOD 

be prepared as usual, the bottles being kept in the 
icebox in the dining car and warmed when needed. 

Milk for the remainder of the journey should be 
thoroughly sterilized by boiling for twenty minutes. 
The same principle may be applied as in canning 
fruits. The jars are thoroughly sterilized, includ- 
ing the covers, and then sealed while the milk is 
still at boiling heat. These should be kept on ice 
and opened only as required. It is better to use 
small bottles, each holding only enough for a couple 
of feedings. 

When people can afford the luxury of trained at- 
tendants a small ice box containing the food may 
be taken along. The necessary ice may readily be 
procured on the train. At certain cities it is pos- 
sible to arrange for a fresh supply of milk from the 
so-called milk laboratories. 

When for some reason it is impractical to carry 
the necessary quantity of milk for a long journey, 
it is usually quite safe to give condensed milk. 

It is always safe, however, to give an occasional 
feeding of the food, beginning several days before 
starting, in order to determine whether the infant 
has an intolerance of that particular food. 

As soon as practicable the proper feedings should 
be resumed. 

All water given the infant on the journey should 
be boiled. 



MISCELLANEOUS 185 

Table Showing the Percentage of Albumen, Fat, and 

Carbohydrate, with the Food Value in Calories in 

One Ounce of the Following Articles of 

Diet (Seifert & Muller). 

Albumen Fat Carbohy- Value 

drate in 

Per cent. Per cent. Per cent. Calories 

Mother's milk 1-1^2 

Cow's milk 2-3 

White flour 11.0 

Butter or other fat 1.0 

Raw lean beefsteak 22 

Raw fat beef 17 

Raw veal steak 15 

Fried veal steak 28 

Roast pork 28 

Boiled ham 24 

Fried bacon 9 

Baked chicken with stuffing 32 

Shell-fish 24 

One egg (iy 2 oz.) 6.5 

Cream (thick) .. . 3.5 

Cheese (Swiss) 27.2 

White bread 8.1 

Baked or boiled potato .. 1.8 

Dried peas 22.5 

Rice (dried) 7.5 

Meat soup o 

Vegetable puree 3 



DIETARY 

Albumen Water. Stir whites of two eggs 
into one pint of cold water. (Do not beat.) Add 
pinch of salt. This food may be used in certain 
digestive disturbances for a short time instead of 
milk. 



3-4 


6-7 


23 


3-4 


4 


23 


i.3 


74.2 


120 


S3 




260 


5.2 


— 


28 


28 


— 


108 


1-3 


— - 


24 


1.3 


— 


43 


10 


— 


69 


36 


— 


146 


76 


— 


249 


4.5 


2.1 


60 


0.5 


— 


34 


4.9 


— 


76 


25.5 


3.5 


87 


30.4 


2.5 


135 


— 


62.5 


97 


0.2 


20.5 


31 


1.8 


52.5 


108 


— 


78.1 


117 


0.8 


— 


7.5 


6.5 


20.5 


53 



1 86 INFANCY AND CHILDHOOD 

Barley Water. 

2 Tablespoons pearl barley, 

i Quart cold water, 

Bring to a boil, simmer one hour. Add sufficient 
water to make one quart. Strain through a cheese- 
cloth. 

To make barley, oatmeal, rice, or arrowroot gruel, 
the same rule may be followed as for barley water, 
substituting the flour for the grain. 

Lime Water. 

i teaspoon slack lime, 

i quart boiled or distilled water. 

Stir thoroughly several times. Then allow lime 
to settle. The upper clear fluid is then ready for use. 

Beef Juice. Broil a piece of lean beef slightly ; 
press out the juice by means of a lemon squeezer 
or meat press. One pound of steak will yield from 
2 to 3 ounces of juice. 

To make Beef Juice by the cold process, take one 
pound of round steak, chopped fine, six ounces of 
water, pinch of salt. Place in a covered jar and put 
in a cool place for five or six hours. Then squeeze 
out the juice. 

Mutton Broth. 

I pound chopped lean mutton with bone, 

i pint cold water, 

Pinch of salt. 

Simmer for three hours, until half a pint remains, 



MISCELLANEOUS 187 

adding water if necessary. Strain through a mus- 
lin and when cool remove the fat. 

Peptonized Milk. In a clean quart bottle put 
the powder contained in one Fairchild's peptonizing 
tubes, and ad t d one-half pint cold water and a pint 
fresh milk. Shake the mixture thoroughly. Place 
the bottle in water at 1 15 F. and keep there for ten 
to fifteen minutes, then place on ice to prevent fur- 
ther digestion of milk. Milk which has been well 
peptonized will have a bitter taste. 

When it is desired to absolutely stop the action 
of the peptonizing powder the milk should be 
brought quickly to the boiling point for a minute 
or two, after the temperature has remained at blood 
heat for ten to fifteen minutes. 

Cocoa. Make a paste of one teaspoon each 
of cocoa and sugar and a little milk or water. Add 
to one cup of milk or water and boil three to five 
minutes. 

Orangeade with White of Egg. 

Juice of one orange, 

White of one egg f 

8 oz. cold water, 

y 2 teaspoon sugar. 

Mix thoroughly without heating. If desired the 
whole egg may be used. 

Scraped Beef and Mutton. Take a tender 
piece of beef or mutton, broil slightly and scrape 



188 INFANCY AND CHILDHOOD 

with a sharp knife. Add a pinch of salt. From 
one-half to one tablespoon with other food may be 
given to a child of from eighteen months to two 
years. 

Coddled Egg (Soft boiled without boiling). 
Place one fresh egg in boiling water, cover, let 
stand at the back of the stove 8-10 minutes. The 
white of the egg should be of a jelly-like consist- 
ency. 

Milk Toast. To one cup of milk add one-half 
teaspoon cornstarch, one-half teaspoon butter, 
rubbed together ; let come to boil. Pour over toast, 
and serve after it has stood long enough for toast 
to become soft. 

Junket or Curds and Whey. Take one pint of 
fresh cow's milk, a pinch of salt, one tablespoon of 
sugar. Add one ounce Fairchild's Essence of Pep- 
sin, Liquid Rennet or one Junket Tablet dissolved 
in water. Stir well. Raise to body temperature 
for twenty minutes, or until firmly coagulated. 
Place on ice until cold. This may be flavored ac- 
cording to taste. 

Custard Pudding. Break one egg into custard 
cup, add a little sugar and mix well. Fill the cup 
with milk. Place in a shallow sauce-pan half pint 
of water and bake and boil ten minutes. 

Other recipes required may be found in any good 
cook-book. 



INDEX 



Additional food, 69. 
Adenoids, in new-born, 8, 

155. 
Adhesive straps, for hernia, 

41; removal of, 41. 
Adrenalin ointment, 126. 
Air, cold and fresh, 54. 
Air passages, taking cold in, 

125. 

Airing out of doors, 54. 

Albumen water, 185. 

Antitoxin for diphtheria, 134, 
135, 136. 

Anus, fissures of, 109. 

Apple sauce, 119. 

Appliances for teaching walk- 
ing, 23. 

Argyrol, in eyes, 46. 

Artificial feeding, 72. 

Astigmatism, 174. 

Atrophy, simple, 175. 

Automobiles for children, 122, 
123. 

B 

Bacteria in intestines, 12. 

Barley gruel, 90, 186. 

Barley water, 186. 

Basket, 39; illustration of, 
frontispiece. 

Bathing, 42; temperature of 
bath, 42 ; tub bath and cold 
baths, 42; warm bath, for 
convulsions, 151 ; bath tub, 
folding, 42. 

Bed-wetting, 171. 

Beef juice, 86, 186. 

Beef scraped, 187. 



189 



Benzoin, tincture, in croup 
and bronchitis, 128, 129. 

Bichloride of mercury, 148. 

Bile in urine, no. 

Binders, flannel abdominal, 
49- 

Bladder infections, 51. See 
also Urine, no. 

Blankets, list of clothing, 48, 

49. 

Bleeding from the cord, 39. 

Bleeding, from stomach, bow- 
els and urinary tract, 150. 

Bleeding of the new-born, 
150. 

Blindness, gonorrhea as 
cause of, 45, 46. 

Blood, 1, 6; circulation of, 6; 
Wassermann test, 146; in- 
jection of blood serum, 150. 

Blood vessels, 6. 

Blue baby, 6. 

Bone, 1, 2; bone cells, 1. 

Boric acid in eyes, 46. 

Bottles, cleansing of, 75, 76; 
kind of, 103; bottles and 
nipples, 77y 95, 96. 

Bowel, large and small, 1, n, 
12. 

Brain, 1, 3 ; growth of, 8. 

Bran and whole wheat flour, 
laxative properties, 90. 

Breasts, enlargement of in in- 
fants, 182. 

Breast feeding, advantages of, 
60, 61 ; position in, 61 ; mor- 
tality in, 60; diseases dis- 
qualifying the mother from 
nursing, 60; table of quan- 
tity, 64; quantity at a feed- 
ing determined by weighing 



190 



INDEX 



before and after nursing, 
64, 65, 68. 

Breast pump, 65. 

Breathing, muscles in, 2, 7; 
chest breathing, 7; abdomi- 
nal, 7; character of, 7; 
rhythm of, 7 ; frequency of, 
8; nose and mouth breath- 
ing, 8; due to adenoids, 127, 

155. 
Breck feeder, 58. 
Bronchitis, 127. 
Brown flour in buttermilk 

formula, 94. 
Bulb syringe, 108. 
Buttermilk, in fat intolerance, 

88, 93; preparation and use 

of, 94; in diarrhoea, 93. 
Button for hernia, 40, 41. 



Caloric values of foods, 79, 
80, 185; of cow's milk, 83; 
of simple articles of food, 
120. 

Calories, definition of, 78, 79. 

Carbon dioxide, 7. 

Carrots, 115, 119, 121. 

Cartilage, 1. 

Catheter, soft and bulb 
syringe, 108. 

Character, development of, 
28, 36. 

Chest, 2; chest wall, 2; de- 
formed chest and hollow 
chest, 123, 124. 

Chest wall, 2. 

Chicken pox, 141. 

Chorea, or St. Vitus' dance, 
158. 

Clothing, in hot weather, 4.8; 
for young infants, 47; list 
of , 48 ; tight clothing effects 
of, 50; for older children, 
179. 

Circulation of blood, 6. 

Circumcision, 45 ; stretching 
of foreskin, 45. 



Cocoa, 187. 

Coddled tgg f 188. 

Coffee, 119. 

Cold air and fresh air, 54; in 
pneumonia, 131. 

Cold in head, coryza or snif- 
fles, 125. 

Colic, 114; soothing syrups 
in, 114. 

Concentration of mind, 28 to 

34. 
Colostrum, 62. 
Condensed milk, 91. 
Constipation, causes and 

treatment of, 106; graham 

bread for, 107. 
Contagious diseases, list of, 

132. 
Convulsions, 151. 
Cord, umbilical, tying of, 39; 

bleeding from, 39; care of, 

39- 

Cough syrups, 129. 

Cow's milk, percentage com- 
position of, 78; clean, 73; 
certified milk, 74. 

Cows, tuberculin tested, 73; 
sanitary conditions of, ^z\ 
breeds of, 75. 

Crackers, graham, 119. 

Cranium, 2. 

Cream, gravity and centri- 
fuge, 79; cream dipper, 80; 
tolerance and intolerance 
of, 81. 

Cream of wheat, 118. 

Crisis in pneumonia, 130. 

Croup, spasmodic, 126; mem- 
branous, 126, 134; catar- 
rhal, inflammation of re- 
spiratory tract, 125. 

Crying, influence of on rup- 
ture, 41. 

Curds and whey, 188. 

Curvature of the spine, 4, 
161 ; posture as cause of, 
124. 

Custard, 116, 119; pudding, 
88. 



INDEX 



191 



Curds, large cheesy, 81 ; small 
white, 87; condensed milk, 
cane sugar content, 91 ; 
casein milk, 95. 



D 

Dairies, sanitary and unsan- 
itary, 73. 

Deafness, directly after birth, 
due to adenoids, 155. 

Deformities, due to posture, 
4, 124; to rickets, 161, 162. 

Delicate children, 176. 

Dentition, time for and 
symptoms from, 99. 

Dessert, 119. 

Development and growth, 13 ; 
mental, 23 ; moral, 26 ; de- 
layed rickets as cause of, 
23. 

Diapers, 49; soiled, 51; char- 
acter of, 51. 

Diaphragm, in breathing, 7. 

Diarrhoea, buttermilk in, 93 ; 
summer diarrhoea, causes 
and treatment of, 166. 

Diet, for children from 1 to 2 
years, 115; second to fifth 
year, 116, 121. 

Diet, for mothers, 67; for 
wet nurse, 71 ; in vomiting, 

113. 

Dietary, 185. 

Digestive tract and digestion, 
9, 10; disturbances of, dur- 
ing hot weather, 48. 

Diphtheria, chapter on, 134; 
intubation in, 138; heart 
condition in, 137; antitoxin 
in, 135 ; laryngeal croup, 

137. 
Discipline, 28 to 36; in eating, 

117; drinking between 

meals, 118. 
Disinfection and fumigation, 

148. 



Ear, middle ear infection, 
131 ; deafness in new-born, 
24; earache, 159; abscess of 
middle ear, 159. 

Eczema, due to over-feeding, 
in; chapter on, 164. 

Education, beginning of, 28; 
list of books on education, 
28. 

Eggs in diet, 115 to 119; cod- 
dled egg, 188. 

Enlarged glands, 157. 

Enlarged tonsils, 156. 

Eruption, smallpox, 141 ; 
chicken pox, 141 ; syphilis, 
146 ; exudative diathesis 
(eczema), 164. 

Erysipelas, 144. 

Eyes, movements of, 9, 24; 
tears, 9; winking of, 9; 
eyelids, 9; proper use of, 
J3 ; care of in new-born, 
45 ; gonorrheal infection 
of, 45, 46, 145 ; defective 
vision, 174 ; squint, 25 ; de- 
velopment of sight, 24; pu- 
pils, 24; in measles, 140. 

Exercise, for babies, 50; ef- 
fects of, 56; effects on 
sleep, 56; chapter on, for 
infants, 121 ; exercises for 
older children, 53, 56, 123. 



Facial movements, 170. 

Far-sightedness, 174. 

Fat, tolerance of, 81. 

Feeder, Breck, 58. 

Feeding, Artificial, 72-98 ; 
cow's milk best substitute 
for mother's milk, J2 ; sub- 
stitutes for fresh milk, 91 ; 
arguments against proprie- 
tary foods, 91, 92; compari- 
son of cow's milk with 
mother's milk, 78; percent- 



192 



INDEX 



age feeding, 78; quantity at 
meal, 82 ; milk formulae, 82 ; 
chart comparing mother's, 
cow's, malted, condensed 
milk, 83 ; at the end of the 
first week, 83 ; after two or 
three weeks, 84; third to 
sixth month, 85 ; sixth to 
ninth month, 86; from 
ninth month on, 86; sched- 
ule for first year, 87 ; sugar, 
89; use of gruels in dilu- 
tion of milk, 90; special 
preparations of milk, 92-95 ; 
bottles and nipples, 95. 

Feeding, Breast, 60-71 ; ad- 
vantages of, 61, 62; proper 
position for, 61 ; first few 
days of, 61 ; first few weeks 
of, 61 ; number of feedings 
63 ; hours for feeding, 66 
frequent feedings, 63 
quantity at a feeding, 64 
chart of quantity of milk 
needed for average breast- 
fed infant during first year, 
64; mixed feeding, 69; 
over-feeding and under- 
feeding, 65 ; wet nurse, 58, 
70. 

Fever, see Temperature, 

Fireplace in nursery, 52. 

Fissures in nipples, 68; in 
anus, 108. 

Flour, browned, 89; by 
weight and measure, 84. 

Fontanels, large and small, 3 ; 
time of closure, 3. Illustra- 
tion, 43. 

Food, how to tell when agree- 
ing, 89; for older children 
from one to two years, 115 ; 
after two years, 116-119; 
caloric value, 120. 

Foreign bodies, swallowed or 
in nose, 181. 

Formaldehyde, 148. 

Formalin candles, 149. 



Fresh air in nursery, 52, 54; 

bronchitis, 127. 
Fruit juice in scurvy, 92. 
Fumigation and disinfection, 

148. 



Gas in stomach and bowels, 
112. 

Gastric secretion, 10; gastric 
juice, 10. 

Gelatine, treatment of bleed- 
ing of new-born, 150. 

Genital organs, care of skin 
around the, 43 ; care of 
male and female, 44; cir- 
cumcision, 45 ; infection 
with gonorrhea, 145. 

German measles, 141. 

Glands, in scarlet fever, 139; 
enlarged, 157; parotid, en- 
largement of, 142. 

Glasses, adjustment of, 175. 

Glycerine suppositories, 108. 

Goitre (thick neck), 159. 

Gonorrhea, chapter on, 145 ; 
involving eyes and urinary 
tract, 45, 46. 

Graduate, pint, 83. 

Green stools, 65. 

Grippe, or influenza, 131. 

Growth and development, 13. 

Gruels, in dilution of milk, 
90; preparation of, 186; 
graham flour gruel, 90; 
graham flour for constipa- 
tion, 108; graham crackers, 
119. 

Gymnasium for older chil- 
dren, 124. 

H 

Habits, 169. 

Hair, of new-born, 5. 

Hammock, for the baby, 53. 

Head, change in shape at 
birth, 2 ; shape later, 3 ; cir- 
cumference of, 20. 



INDEX 



193 



Hearing, development of, 24. 
Heart, 2; valves of, 6; heart 

beat, frequency of, 6. 
Height, 18. 
Hemorrhage of the new-born, 

150. 
Heredity, 27, 28. 
Hernia, 40; crying as cause 

of, 41 ; treatment of, 41 ; 

illustration, 41; hernia in 

the groin, 41. 
Hip joint disease (see Tuber- 
culosis), 133, 134- 
Hives, following antitoxin, 

136; chapter on, 163. 
Hooping cough (whooping 

cough), 142. 
Hot water bottles, danger of, 

39; in incubator, 59. 
Hours for nursing, 66. 
Hunger, 24. 
Hydrocephalus, 20. 
Hydrochloric acid, 10. 



Ice box, yy 9 97; description 

of, 98. 
Ice water, 116. 
Incubator, 57; improvised or 

home-made, 59. 
Immunity to disease of 

breast-fed babies, 61. 
Indigestion, at beginning of 

artificial feeding and from 

over-feeding, y2. 
Influenza, grippe, 131. 
Inhaler, for croup and bron- 
chitis, 128. 
Inheritance, 27. 
Injections, for constipation, 

109. 
Instinct, 24. 

Insufficient milk, 58, 61. 
Intelligence, 28. 
Intestines, small and large, 

11, 12; digestion in, 11; 

length of, 11; bacteria in, 

11, 12; disturbances of di- 



gestion due to too much 
clothing, 48. 

Involuntary movements, 23. 

Ipecac, in treatment of spas- 
modic croup, 127. 



Jaundice of the new born, 

150. 
Jaws, undeveloped condition 

of, 2. 
Junket, curds and whey, 188. 

K 

Kidneys, inflammation of, 

with erysipelas, 144. 
Kissing, 54, 169. 



Lactone milk, 93. 
Lancing the gums, 102. 
Legislation, Introduction, 
Length, increase in, 16; table 

of, 17. 
Ligaments, 2, 5. 
Lighting the nursery, 54. 
Lime salts, 1. 
Lime water, 186. 
Loss in weight after birth, 20, 

61; from overfeeding, in. 
Lungs, 2, 7. 
Lymph, 7. 
Lysis in broncho-pneumonia, 

131. 

M 

Malnutrition, due to improp- 
er food, 91-92, 175. 

Malt soup, preparation of, 94. 

Marasmus, 175. 

Massage, abdominal for con- 
stipation, 108. 

Masturbation, 172. 

Measles, 140 ; German 
measles, 141. 



i94 



INDEX 



Measurements of head, chest 

and height, 17. 
Meat, carrier of contagion, 

74- 

Mechanical devices for exer- 
cise and walking, 123. 

Meconium, 105. 

Melena neonatorum (bleed- 
ing of the new-born), 150. 

Membranous croup.. 135. 

Membrane in throat, 134. 

Memory. 29. 

Mental condition of nursing 
mother, 64. 

Mental development, 23, 26- 
30; tests, 26. 

Menstruation of nursing 
mother, 67. 

Microcephalia, 3. 

Milk crust, 164. 

Milk, mother's milk and cow's 
milk, composition of, 78; 
percentages of fat, sugar 
and proteid, 78; breast 
feeding, importance of. 60; 
mental condition of mother 
as influencing. 64; menstru- 
ation of mother as influenc- 
ing, 67 ; secretion of, 61 ; 
quantity secreted, 64 : mixed 
feeding, 69 ; clean milk. 73 ; 
certified, 74; care of, in 
home, 75 : richness of, 75 ; 
whole milk, 79; modifica- 
tion of, 79; formulas, 82-87; 
quantity at meal or in 24 
hours, 86: as carrier of dis- 
ease, 75 ; milk wagon, 73, 
75 ; pasteurization and ster- 
ilization of, 74-76 : boiling 
of, 76; advantages over im- 
proper pasteurization, 76 ; 
special preparations of, 92 ; 
peptonized, 92, 187: sour 
milk, buttermilk. 93, 94; 
casein, 95 ; whey, 95 ; 
skimmed. 93 : for traveling, 
substitutes for, 91 ; con- 
densed, 91; malted, 94; 



charts showing contents of 
mother's milk, cow's milk, 
condensed milk, malted 
milk, 83 ; for older children, 
117, 118. 

Milk toast, 188. 

Mittens, list of clothing, 49. 

Moral development, home 
training, 26. 

Mortality of infants, Intro- 
duction. 

Motion, freedom of, 50. 

Mother, nursing, mental con- 
dition of, 64; overfeeding 
of, 67, 

Mouth breathing, 127, 155 ; 
adenoids as cause of cough, 
128. 

Mouth, care of, 46, 47; swab- 
bing, 46. 

Movements, 22 ; impulsive 
and reflexive of head, 22. 

Mucous membrane, color of, 
5,6. 

Mumps, 142. 

Muscles, 2; coordination of, 
26. 

Mustard plasters in bron- 
chitis, 129. 

Mutton, broth, 186; scraped, 
187. 

N 

Nasal passage, blockade of, 

125. 
Navel, care of, 40. 
Nerves, 4; spinal, 4. 
Nervous mental condition, 

26: tests of, 26. 
Nettle rash, hives, urticaria, 

163. 
New born, care of, 39. 
Nipples, artificial, care of, 77 ; 

kinds of, 95-96; picture of, 

96. 
Nipples, fissures of, 68, 69. 
Nipple shields, 69. 
Normal infant, 21. 



INDEX 



195 



Normal salt solution, 40. 
Nurse, 37 \ training for, 37. 
Nursery pen, 55, 122. 
Nursery, temperature of, 53; 

general consideration of, 

52; lighting of, 54. 
Nursing Bottles good and 

bad, 96-97; correct shape, 

97. 
Nursing, technique of, 61, 63; 
night nursing, 66; hours 
for, 66; intervals between, 
66 ; refusal to nurse, 68. 

O 

Oatmeal, 90, 118, 186. 
Opium in cough syrups, 129; 

in soothing syrups, 114. 
Orangeade, 187. 
Orange juice, with sterilized 

foods, 92; to prevent and 

cure scurvy, 92; at meal, 

118. 
Orthopedic surgeon, 124. 
Overfeeding, 65; of mother, 

67; chapter on, in; as 

cause of colic, 114. 
Overheated houses, as cause 

of bronchitis, 127. 
Oxygenation of blood, 6. 



Pacifier, 170. 

Packs in bronchitis, 128. 

Pancreas, 11. 

Paralysis, in diphtheria, 137; 
of the heart, 137. 

Pasteurization and steriliza- 
tion of, 74, 96, 97. 

Pasteurization, improper, 76. 

'Pasteurizers and sterilizers, 
picture and description of, 
97- 

Patent foods, 62, 83, 91 ; cost 
of, 62. 

Pepsin and hydrochloric acid, 
10. 



Peptonized milk, 92, 187. 

Peptonizing tubes, 92. 

Perambulator, 54. 

Percentage feeding, 79. 

Physiology of infant, 1. 

Pineapple, 119. 

Pin or thread worms, 153. 

Pins, 49; safety pins, danger 
of, 51. 

Pneumonia, lobar, 130; bron- 
chial, 130; in measles, 140; 
in grippe, 131 ; complication 
in whooping cough, 143. 

Posture, proper for feeding, 
112; as cause for regurgi- 
tation and vomiting, 112; 
correct and incorrect in sit- 
ting, 124. 

Pregnancy in nursing moth- 
ers, 68. 

Premature infants, 57 to 59. 

Prickly heat, 48. 

Proprietary foods, 91 ; argu- 
ments against their use, 92 ; 
as cause of malnutrition, 
rickets, and scurvy, 91-92. 

Prunes, 119. 

Puberty development, during, 
14, 16, 17, 177. 

Puddings, 119. 

Pulse in diphtheria, 137. 

Punishment, 36. 

Pupils, reaction to light, 24. 

Pylorospasms, or Stenosis, 
112. 

Pylorus, 10. 

Q 

Quantity of food at a meal, 

64, 82. 
Quarantine, 147, 148. 



Rash, accompanied by sniffles, 
125; blotchy, 140; nettle- 
rash, 163. 

Recurrent vomiting, 113. 



196 



INDEX 



Reflexive movements, 23. 

Refraction, errors of, 174. 

Refusing the breasts, 68. 

Regurgitation, tight clothing 
as the cause of, 50; over- 
feeding, in; posture, 112; 
other causes, 112. 

Rennet, 10. 

Respiration, 7. 

Respiratory tract, diseases of, 
125-130. 

Restlessness during sleep, 56. 

Rheumatism, 158 ; complica- 
tion of tonsilitis, 158. 

Rice, 90, 115, 120. 

Rickets, shown by slow clo- 
sure of fontanels, 3; as 
cause of delayed develop- 
ment in walking, 23 ; due to 
proprietary foods, 91-92 ; 
chapter on, 161. 

Round worms, 152. 

Rupture, 40; tight clothing as 
cause of, 50. (See Hernia.) 

S 

Safety pins, 51. 

Sago, 119. 

Salivary glands, 10. 

Salt solution, normal, 40. 

Salts in milk, 78 ; whey, 95. 

Scales, 15. 

Scarlet fever, 138; streptococ- 
cus, as cause of, 138; en- 
largement of glands, mid- 
dle ear, 139; kidneys, 139; 
scaling, 140. 

Scraped beef, 187. 

Scurvy, due to sterilized food, 
92; use of fruit juice in, 92. 

Secretion of milk, 61. 

Self control, 33. 

Sense, organs of, 9; special, 
24. 

Shade, 54, 55- 

Shirts, list of clothing, 48, 49. 

Sight, development of, 24. 

Silver nitrate in treatment of 
eyes, 46. 



Simon-Binet, test, 26. 

Simplex vaporizer for croup 
and bronchitis, 128. 

Skeleton, 1. 

Skin, color and character of, 
5; care of, around genitals, 
43 ; irritation of, 21, 43. 

Skull, 2; sutures and fonta- 
nels, 41. 

Sleep, 55 ; restlessness during, 
56. 

Smallpox, 141. 

Smell, 24. 

Soap, influence on skin, 42, 
43; kinds of, 43. 

Soothing syrups, 114. 

Soup, vegetable, 118. 

Sour milk, 93. 

Spasmodic croup, 126. 

Special senses, instinct, hun- 
ger, thirst, fatigue, 24. 

Speech, 25. 

Spinach, 118, 120. 

Spinal canal, 4. 

Spinal column, 4. 

Spinal cord, 4. 

Spine, curvature of, 4. 

Spru, Stomatitis, 165. 

Squint, 9. 

Standing and walking, 23, 41. 

Starch, 90. 

Steam kettle, 128. 

Steam tent in laryngeal diph- 
theria, 129, 138. 

Sterilization and pasteuriza- 
tion of milk, 74, 97; illus- 
tration, 96, 97. 

Stomach, gastric juice in, 10; 
position of, 10. 

Stools, green, 65, S3, 106 ; pale 
and dry, 108; large curds 
in, 87 ; small curds in, 87 ; 
acid and loose, 88; chapter 
on, 105 ; character in arti- 
ficially fed, 106; color of 
due to malt food, 106; con- 
stipation, 107, 108; foul, 
in; sources of infection, 
134. 



INDEX 



197 



Structure of the body, i, 

St. Vitus' dance, 158. 

Sucking of ringers, 22. 

Sucking, organs involved in, 
9, 10. 

Sugar, varieties in feeding, 
malt, cane and milk, 89; by- 
weight and measure, 84. 

Sunshine in the nursery, 52. 

Suppositories, 108. 

Sutures, 2. 

Swabbing of the mouth as 
cause of spru, 46, 165. 

Sweets in diet, 117. 

Syphilis, in premature in- 
fants, 57; in wet nurse, 71 ; 
sniffles, as symptoms of, 
125; other symptoms, 146; 
chapter on, 146. 

Syringe, bulb, 109. 



Table, folding, for use in 
nursery, 50. 

Talcum powder, 49. 

Talking, 25. 

Tape worm, 152, 153. 

Tapioca, 119. 

Taste, development of, 9, 24. 

Teeth, development of, 3; 
temporary, 99; permanent, 
100; care of, 102. 

Teething, time for, 99, 101 ; 
symptoms from, 101. 

Temperament, 33. 

Temperature, of room, 39; of 
nursery, 53; of body, 56; in 
pasteurization, 75; of incu- 
bator, 58. 

Tests for special senses, 26; 
mental, 26 ; Simon-Binet 
system, 26. 

Thermometer, clinical, 56; in 
incubator, 59; dairy in pas- 
teurization of milk, 97. 

Thermos bottles, yy. 

Thick neck goitre, 159. 

Thirst, 29. 



Thumb-sucking, 169. 

Thread worms, 154. 

Thrush, 165. 

Tight clothing, effects of, 50. 

Toast, milk, 188. 

Tongue-tie, 104. 

Tonsils, enlarged, 156. 

Toys, 180. 

Training, home, 26. 

Transfusion of blood for 
hemorrhage, 150. 

Trusses, yarn, 41. 

Truthfulness, 34. 

Tub baths, 42. 

Tuberculin tested cows, y^. 

Tuberculosis, bacillus, 132; of 
lungs, 133; glands, 133; 
bones, 133; hip joint and 
knee, 134; milk, 133; cows, 
133 ; of the mother, 60 ; as 
reason for not nursing, 60; 
wet nurse, 71. 

U 

Umbilical cord, tying of, 39. 
Umbilical hernia, 40. 
Umbilical opening, 41, 49. 
Under-feeding, 65. 
Urethra, infections of, 145. 
Urine, odor of ammonia in, 

88; chapter on, no. 
Urticaria, 163. 

V 

Vaccination, for smallpox, 

168. 
Valves, of heart, 6. 
Vaginal discharges, 44, 145. 
"Vanta" garments, 51. 
Vaporizer, simplex, 128. 
Vegetables, for constipation, 

108, 116. 
Ventilation, 39, 52. 
Vertebrae, number and shape 

of, 4. 
Vision, defective, 174. 
Vomiting, due to posture, 



198 



INDEX 



112; overfeeding, 85, 112, 
113; general causes, 112; 
before the next meal, 113; 
recurrent, 113. 

W 

Walking, time for, 23; de- 
layed, as result of rickets, 
23 ; appliances in aid of, 23. 

Wash cloths, 44; as sources 
of infection, 44. 

Wassermann reaction, for 
syphilis, 16; in wet nurse, 

7i. 

Weaning, 70. 

Wet nurse, for premature ba- 
bies, 57, 70; diet and exer- 
cise of, 71. 

Wetting the bed, 171. 

Weighing, 16; scales, 15; be- 
fore and after nursing, 21, 
68. 

Weight, at birth, 13 ; gain in, 
for first year, 13 ; second to 
fifth years, 14; loss in, after 
birth, 20 and 61 ; table of, 
17; chart, 19; rapid gain, 



81 ; normal gain, 13, 04 ; 

loss of, due to overfeeding, 

in. 
Wheat flour, 90. 
Whey, 95 ; curds and whey, 

188. 
Whole wheat flour, 90. 
Whooping cough, 142. 
Windows in nursery, open, 

52. 
V\ inking, 9. 
Witches milk, 182. 
Woolens, 48. 
Worm powder, 153. 
Worms, intestinal, 152; tape 

worm, 152 ; thread or pin 

worm, 154; round worm, 

154. 
Wounds, care of, 182. 



X-Ray, in location of foreign 
bodies, 181. 



Yarn trusses, 41. 



u I !,m^ ARY 0F CONGRESS A 

" ' " " i! mil II mi • I 



022 169 364 4 



